• September 20, 2004
• Vol. 62
• No. 12

Midlife Crisis

By Susan Schindehette

Recovering Well from Quadruple Heart Bypass, Junk-Food-Loving Former President Bill Clinton Now Must Stick to a New Economic Plan—Low Fat, All the Time

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From PEOPLE Magazine

On the eve of Sept. 6 quadruple bypass surgery, Bill Clinton sat up in his room at New York-Presbyterian Hospital, playing Boggle and cards with wife Hillary and daughter Chelsea and talking on the phone to his closest friends. Paul Begala, his longtime political adviser, called right around dinnertime, when Chelsea had brought in Italian food for the family from one of her favorite restaurants. "I heard Bill call out to Hillary and say, 'I guess a Big Mac and banana split is out of the question," says Begala.

It sure is now. By all accounts the four-hour surgery, in which a 12-person team took sections of artery and vein from the former President's chest and leg and used them to detour around the blockages in his heart, was a success. Later, doctors revealed that several of the President's arteries were "well over 90 percent blocked." Said Dr. Allan Schwartz, chief of the hospital's cardiology division: "There was a substantial likelihood that he would have had a substantial heart attack in the near future."

Ironically, Clinton's health crisis came not during the days when, with a cholesterol level of 233, he was dubbed "Tubba" on the late-night talk shows. During the past two years, he'd lost about 40 lbs.–thanks to a stepped-up exercise regimen and the low-carb, low-fat South Beach diet. At last month's Democratic National Convention, the newly svelte Clinton "looked the best he had in years," says longtime aide Neel Lattimore, "and he said he was feeling great."

Looks can be deceiving. Although Clinton, 58, passed his stress tests with flying colors during his White House years, according to former aide Mike McCurry, "during his last checkup [as President] in 2000 his annual physical showed elevated cholesterol levels." In recent months, Clinton, who at one point was taking a statin drug to lower his cholesterol, began to experience chest pain and shortness of breath, but blamed them on a break in his exercise regimen and on a diagnosed case of acid reflux. Then, just days ago, things got markedly worse. "Even out walking with Hillary the other day," says Democratic National Committee chairman and good friend Terry McAuliffe, "he got winded." Before dawn on Sept. 3, Clinton, again experiencing discomfort, went to Northern Westchester Hospital near his Chappaqua home. That day, doctors recommended immediate surgery.

Even though Clinton had been following a healthier lifestyle in recent years, once the damage is done, say doctors, it can't be rectified overnight. "You can't reverse years of disease progression with a short interval of treatment–lifestyle changes and medications," says Robert Eckel, professor of medicine and president elect of the American Heart Association. "Modifying risk factors takes time to benefit the arteries–six months to several years."

Though genetics are an important risk factor in heart disease (Clinton has a family history of it), diet is also a key factor. "It takes about 20 years [of eating cholesterol-rich foods] to get enough build-up to get symptoms," says Dr. Paul Corso, chief of cardiovascular surgery at the Washington Hospital Center. And Clinton fit that bill. Begala, now cohost of CNN's Crossfire, recalls Clinton eating up to seven meals a day on the campaign trail. "Everywhere we went we had the best local food, barbecue in the South and Mexican food in Texas and Italian food in the Northeast," says Begala. "We ate our way across America." Even during his recent healthy phase, he was known to fall off the wagon, as he did on Sept. 1 in New Orleans, having a breakfast of beignets (fried doughnuts covered with powdered sugar), followed by a lunch in the French Quarter of rich sausage gumbo, battered catfish sauteed in butter and black-eyed peas.

For now, both Hillary, who "was ashen and distraught," says a friend, after hearing that her husband needed surgery, and daughter Chelsea, who flew in from a business trip in Paris to be with her father, are staying by his side. The President flashed a thumbs-up after coming out of anesthesia, and doctors expect full recovery in two to three months. But Begala, for one, says it's unlikely he'll hit the campaign trail as planned for the coming election: "It takes so much energy for him." Not that he won't want to. "They're going to have to restrain him, and Hillary and Chelsea will be the wardens," says Lattimore. "He doesn't know the meaning of the word 'rest.' In fact, it must have killed him not to be able to do a meet-and-greet in the operating room."

By Susan Schindehette. Sharon Cotliar, Diane Herbst, in New York City, Marianne V. Stochmal in Chappaqua, N.Y., and Macon Morehouse and Linda Kramer in Washington, D.C.

• Contributors:
• Sharon Cotliar,
• Diane Herbst,
• Marianne V. Stochmal,
• Macon Morehouse,
• Linda Kramer.

More From This Article

A Man and His Meals: What's Next?

THE "TUBBA" YEARS

DIET: Corn-battered catfish, beef chunks marinated in bottled Italian salad dressing, enchiladas with canned chilies and tomatoes, and sweet lemon-cheese pie. Says aide Neel Lattimore: "The man loves good food." EXERCISE: Clinton's 6'2" frame reached 226 lbs. during the 1992 campaign. As President, he started running three miles, five times a week around the capital. BOTTOM LINE: Bad shape.

THE GREAT SUM-DOWN

DIET: In the post-White House era, he followed the low-carb, low-saturated-fat South Beach diet. At Lange's Little Store & Deli in Chappaqua, "he eats pretty healthy," says manager George Haletzky—egg-white sandwiches for breakfast, carryout turkey sandwiches for lunch. EXERCISE: Hired a personal trainer, installed a treadmill and home gym in Chappaqua. Played golf, kept up his running. BOTTOM LINE: A step in the right direction.

POSTSURGERY

DIET: Clinton's doctors can be counted on to order up an eating plan that's low in salt and saturated fats and includes fruits, vegetables and whole grains. They'll also likely prescribe small doses of aspirin for its blood-thinning properties and some form of cholesterol-lowering statin drug. EXERCISE: Experts recommend at least 30 minutes of pulse-raising activity five times a week. BOTTOM LINE: A healthy prognosis.

Too Little, Too Late?

Former President Bill Clinton's recent slim-down and shape-up doesn't seem to have made him heart-healthy. And that may cause some midlife treadmill jockeys to wonder: Is it worth it? According to the experts, the answer is yes—though they emphasize that heart conditions that have taken decades to develop can't simply be turned around overnight. "If there are years of risk factors that aren't well controlled, a short-term push is like stopping an express train," says Dr. Robert Bonow, chief of cardiology at Northwestern University medical school. "It's got momentum and may continue for a while before losing steam."

In truth, diet and exercise alone may not be able to completely stop arterial plaque formation. But there is tantalizing, preliminary data suggesting that a new treatment—injecting a form of "good" HDL cholesterol—can actually make arterial plaque dissolve. Even if that eventually proves not to be the case, says Bonow, "I wouldn't want to give the impression that now that you're 55, there's no reason to change lifestyle. Whatever your age, healthy habits can slow the disease down."

The Man Who Performed the Operation

There was a moment during President Clinton's quadruple bypass when his surgeon, Dr. Craig Smith, 55, chief of the cardiothoracic surgery division of New York Columbia Presbyterian Hospital, quite literally held the patient's heart in his hands. Was he nervous? "I do it every day," says the unassuming doctor. "The last thing I focused on was that it was the President's heart."

For Smith, one of the country's top cardio surgeons, who performs some 350 surgeries a year, about half of them bypasses, Clinton's procedure was all in a day's work. On Sept. 3, as the Cleveland native was driving to his summer home in the Adirondacks, where he planned to celebrate his 34th anniversary with wife Trish, a lawyer, he got an urgent call on his cell phone, informing him that his services were needed. "We looked for an exit," he says, "and turned around."

A former college fullback, father of three grown girls—and a $2,000 contributor to President Bush's reelection campaign—Smith is known for his surgical use of robotic devices and lasers. His operation on Clinton, however, used conventional methods. His most famous patient to date was certainly no less grateful than those who have come before: When doctor saw patient post-op, Clinton "thanked me," says Smith. "Many times."