- - Wednesday, October 9, 2019

ANALYSIS/OPINION:

I don’t know Sen. Bernie Sanders. What I do know is that he is 78 years old with a prior medical history of gout and high cholesterol. Now I also know that he has heart disease, like 15 million other Americans. He had chest pain in Nevada while campaigning last Tuesday, and by Wednesday had two stents inserted into one of his coronary arteries which supplies the heart with needed nutrients, while the other arteries, according to his doctors, remained open. 

These days, the technology behind coronary artery stenting is simply amazing. A catheter is threading into one of the tiny arteries that supplies the heart, a balloon then re-expands the closed or nearly closed vessel, and a mesh stent covered with a polymer and treated with a special chemical to prevent the vessel from re-occluding (successful the vast majority of the time) is inserted.

In Bernie Sanders’ case, the procedure was successful, but according to his doctors, he sustained damage to his heart likely in the time leading up to the procedure. Since he was discharged from the hospital after just three days, one can conclude that the heart attack was small.

Still, in my opinion it was probably unwise for him to be flying on an airplane so soon (he returned to Vermont this past weekend), because of the variable cabin air pressures as well as the lack of medical facilities while en route. He had said he planned on returning right away to campaigning, and I thought this could be too ambitious as well given the rigors and stresses of the campaign, especially preparing for the debate scheduled for Oct. 15. Stress has been associated with an increase risk of heart problems in part because of the stress hormones released. Now he says he will scale back his campaigning, which I think is wise.

Mr. Sanders’ never-say-die approach and his refusal to give into his heart disease is inspiring, but it may also be foolish. He is likely now on a combination of blood thinners (including aspirin), a heavy dose of cholesterol-lowering drug (statin), as well as a medication to take the pressure off the heart and possibly to lower heart rate.



More and more people are living active unhindered lives after both stent placements and small heart attacks, and the recovery time is shorter than ever. But there is still a necessary transition back to a regular routine, especially for such a high-stress pursuit as running for president of the United States. I must caution that heart disease is still the No. 1 killer in the United States, despite all the new technologies, with more 600,000 dying of this every year, one out of every four deaths. Unfortunately, too many patients are not following the medical advice of their doctors or taking too few precautions. Bernie Sanders appears to be one of them. 

At the same time, I wouldn’t underestimate the importance of his positive attitude and strong will. 

I wish Mr. Sanders a speedy recovery, and it appears that he was the recipient of excellent expeditious care. This clearly plays an important prognostic role. Unfortunately, not everyone has access to this same level of care. The Medicare-for-all type of program Mr. Sanders supports is characterized by waiting times even when it comes to urgent heart procedures. In Canada, this access has steadily improved, and the technology is generally top notch.

Still, obtaining the needed care in a timely manner in order to reduce risks of complications and improve outcomes for heart disease remains problematic in many regions of that country. I am glad, for Mr. Sanders’ sake and millions of others, that we don’t have that access problem as commonly here in the United States. 

• Marc Siegel, a physician, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical correspondent.

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