Tim Russert's Death: Questions, Answers

June 16, 2008 -- Newsman Tim Russert's death last Friday from a heart attack caught many people by surprise.

NBC News reports that Russert, 58, collapsed at work and that resuscitation attempts were made at a nearby hospital, to no avail.

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Russert's doctor, Michael Newman, MD, says an autopsy showed that the heart attack was caused by cholesterol plaque rupturing in a coronary artery and that Russert had an enlarged heart.

Russert was known to have coronary artery disease that was well controlled with medication and exercise; he had performed well on a stress test in late April, according to NBC.

WebMD spoke with three cardiologists -- none of whom was treating Russert -- about Russert's death:

• Cam Patterson, MD, chief of the division of cardiology at University of North Carolina at Chapel Hill.
• Robert Ostfeld, MD, cardiologist at Montefiore Medical Center in New York.
• Douglas Zipes, MD, past president of the American College of Cardiology and distinguished professor of medicine at Indiana University.

Russert's heart attack was caused by a sudden coronary thrombosis that happened when cholesterol plaque ruptured in an artery. Please explain how that happens.

Zipes: What happens is a cholesterol plaque builds up on the inside wall of the artery, and when the cap of the cholesterol plaque is weak, it can then rupture, spewing cholesterol and other chemicals ... into the bloodstream. When the [chemicals] come in contact with platelets, the platelets clump and occlude the coronary arteries [causing a heart attack].

Patterson: Based on the physician's report that we heard and also what we know about the natural history of this process, he'd had coronary artery disease for many, many years, if not decades, and he probably had plaque that built up over many years due to factors -- some of which may be under his control, some of which may be outside of his control -- that led to cholesterol buildup in the arteries around his heart. And at some point on Friday -- for reasons that none of us are able to understand or predict, even with the best tests -- his plaque ruptured.

Ostfeld: Atherosclerosis, the disease that may ultimately lead to a heart attack, is a disease process that develops within us over decades. This is a disease process that starts very early in life.

Is there any way to predict plaque rupture?

Patterson: Not right now. There's no test we can do in humans to predict that. We're working on developing tests, but they're really in the animal model stage right now for identifying vulnerable plaque.

There are some therapies that we know reduce the frequency of plaque rupture. In particular, high-dose statin therapy. The other thing that I think is important from a therapeutic standpoint is the power of aspirin. Aspirin can certainly help to prevent or reduce the complications related to plaque rupture.