Bill Clinton: In 2004, former President Clinton had a quadruple bypass operation that did not require stents and did not increase risk for clotting. In February, 2010, he had chest pain and tests showed that his heart muscle was not getting the blood it needed, so doctors opened up the arteries leading to his heart and put in two stents. Since Clinton had chest pains and appeared to be having a heart attack, he probably needed the stent to open the blocked heart artery. The indication for stents is to prevent heart muscle death from complete blockage of blood flow.

While President of the United States, Bill Clinton was famous for his unhealthful diet of hamburgers, steaks, barbecue, French fries, doughnuts, sugared drinks and lots of desserts. Today he is a vegan and has lost more than 25 pounds. He eats veggie burgers and lots of fruits and vegetables. He eats no meat, dairy, eggs or added oils. He is now a role model for people who want to prevent heart attacks and I think he has a very long life ahead.

George W. Bush: On August 6, 2013, 67 year-old former President George W. Bush had his yearly physical examination at the Cooper Clinic in Dallas. It showed that one heart artery was more than 95 percent blocked and therefore Bush was at very high risk for a heart attack. Less than 24 hours later he had a stent put in a heart artery. A spokesman told reporters that Bush did not have chest pains, an accepted indication for putting in a stent to open up blocked heart arteries to prevent the heart muscle from dying from lack of oxygen. Since Bush did not have any chest pain, he was less likely to have had an acute heart attack and probably could have done very well without the stent. People can suffer heart attacks without suffering chest pains. Putting a stent into an artery increases risk for forming clots in that artery, so all patients who have stents have to take drugs that prevent clotting for the rest of their lives.

Bush had a history of lifestyle risk factors including being a former smoker and drinker of excess alcohol, and eating an unhealthful diet, but he exercised regularly and had no prior history of heart trouble. He was an athlete who had played baseball at Yale and was a serious runner until he switched to mountain biking after injuring his calf muscle in 2003. He has done at least three 100-kilometer (62-mile) Warrior 100K charity bike rides. Within a few days after the stent was placed in his artery, Bush resumed exercising on the elliptical machine and playing golf. However exercise does not prevent heart attacks in people who eat unhealthfully. Bush’s White House chef reported that his favorite food was cheeseburgers on top of his pizza. He has maintained a reasonably healthful weight, but I do not know if he has made any changes in his diet.

For more on stents and prevention of heart attacks see Too Many Stents