I was deeply saddened when I heard about the sudden death of Tim Russert, the host of TV's popular "Meet the Press." He was 58, at the top of his career, when an arterial plaque ruptured. A resultant blood clot apparently caused ventricular fibrillation, a wild arrhythmia that effectively stopped the normal pumping activity of his heart muscle-a classical and deadly scenario in cardiovascular disease. Russert had asymptomatic coronary disease that was under control with medication and exercise, his doctor said.

This headline death carries multiple messages for all of us. It brings attention to one of the most insidious realities in cardiology. Ninety percent of the time, people with coronary artery disease are asymptomatic. And 50 percent of the time, the very first symptom is sudden death. Some 300,000 Americans die of sudden cardiac arrest each year without knowing they have heart disease. Russert was conscientious about his health. He knew he had heart disease, was being treated for it, but it still didn't help him.
If a patient complains of typical symptoms like jaw or chest pain, we can jump on those clues, do the tests, and start treatment aimed at stabilizing plaque and preventing a heart attack. At least we have a chance to head off a disaster. Sometimes we may only be able to delay it.
Russert's death reminds us all of our vulnerability in the fast-paced nature of our society. In his case, it looked like he had just taken an overnight flight from Europe and was busy working the day he died. Modern life is full of ups and downs, and stress and pressure that affect the heart in a way that most people, even doctors, don't fully appreciate. Stress kills, accelerating arterial disease and its most powerful risk factors: blood pressure, heart rhythm disturbances, insulin resistance, the tendency to clot, smoking, alcohol, drug use, and insomnia. On top of that, our arteries are besieged by mercury, lead, sugar, bacteria, and other damaging inflammatory agents.
Russert's death evoked multiple flashbacks to my days as a young cardiologist when I lived in fear of patients dropping dead while I treated them. I saw it happened too many times: a truck driver stressed by traffic and delivery deadlines, a businessman who couldn't take the pressure anymore, a person fired from a job, somebody going through a nasty divorce, and even my own father who died in my arms from sudden cardiac death. I've seen many life dramas end in the emergency room or my office. They are the most devastating situation that occurs in medicine.
Years ago in this pressure cooker situation I rapidly became aware of my own vulnerability. and I started popping aspirin. I remember one high-level attorney I was treating in my office who was having an acute heart attack. He refused to go to the emergency room. I said I would drive him myself. It was only a short three-minute ride. Reflexively, I pulled out an aspirin and started chewing it.
"Why are you doing that?" he said.
"Because I am afraid I am going to have a heart attack dealing with you," I answered.
He got the message. He saw that I was serious, that he could really die, so he relented. I drove him to the emergency room and we had a happy ending.
More than fifteen years ago I learned about fish oil, which became the main weapon in my anti-plaque program. Fish oil protects against sudden cardiac death, as was first discovered by Danish researchers back in the 1970s. They found that Greenland Eskimos had a low incidence of heart attacks compared to Westerners. The Danes linked the hardiness of Eskimo hearts to a diet with abundant fish oil, which they felt had potential anti-atherosclerotic benefits. This original study inspired more than 4,500 scientific investigations of fish oil on metabolism and health, and resulted in repeated confirmation of cardiovascular benefits.
One of the most impressive studies was the famous GISSI prevention trial in Italy during the 1990s. In this study, researchers monitored more than eleven thousand highly vulnerable patients who had suffered a recent heart attack. They found that the patients who took a 1 gram supplement of fish oil daily had a dramatic decrease in sudden death of more than 40 percent compared to non-supplemented patients. These results are rendered even more extraordinary by the fact that all the patients in the study were being treated with standard medication and, in general, eating a protective Mediterranean diet.
When you ingest fish oil it gets within the structure of any arterial plaque within three days, making the plaque much less prone to rupture. Fish oil reduces inflammation, improves the variability of the heart rate, and makes the blood less sticky. Those are all cardiology goals.
I don't know if Tim Russert took fish oil. I do know that a lot of doctors fail to recommend fish oil to their patients despite all the research. Last year a survey was conducted among Washington State family physicians to determine their prescribing frequency of fish oil supplements as a form of prevention against heart disease. Fully 99 percent of them agreed on the importance of nutrition in preventing cardiovascular disease and 57 percent knew of fish oil's effectiveness, but only 17 percent prescribed it to any significant degree! That's a serious disconnect, and a tragic one in my opinion.
If there is one thing I consistently rely on for my cardiac patients, it is adding fish oil to their plaque stabilization and prevention program. It can make the difference between life and death! Preventively, everybody on the planet should be getting some fish oil-at least one gram a day through the diet (good quality fish like wild salmon) or a supplement. For existing heart disease I recommend 2 grams.