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    Tim Russert's Death: Questions, Answers

    Get Answers to Questions About Tim Russert's Heart Attack -- And Your Own Risk

    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.

    Russert's coronary artery disease was said to be well controlled with medication and exercise. Why did his heart attack happen anyway?

    Patterson: When we talk about having coronary disease being well controlled, what we usually refer to are the symptoms of chronic blockages. And it's important to remember that chronic blockages are very different from plaque rupture, which is what killed him. He may very well have been treated very effectively to reduce symptoms from the chronic blockages, but we don't have any therapies that specifically prevent plaques from rupturing.

    Would he have been a candidate for more aggressive treatment?

    Zipes: I'd need to know more about him. For example, if he had significantly reduced heart function -- an ejection fraction of 35% or less -- he would have been a candidate for an implantable defibrillator.

    Is it possible that the care he did get actually did prolong his life?

    Ostfeld: That's a great point. That's very possible. It's possible that without having his medical problems treated and without having a healthy lifestyle, his heart attack may have been 10 years earlier.

    The autopsy showed that he had an enlarged heart. How does that happen, and how might that have played a role?

    Zipes: It could be that he had previous heart attacks, and that can then produce scarring and dilation of the heart. A heart attack, in about 10% of individuals, may be asymptomatic, so you have no chest pain associated with that. It's even higher in diabetics, and I read some place that he was diabetic, so he could have had an asymptomatic heart attack in the past. Or he could have had other causes. ... Most commonly, given the autopsy and what happened to him, it was due to the coronary disease.

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