Count me among the surprised last week when word got out that former President George W. Bush had a minimally invasive heart procedure to open a blocked artery.

Immediately after the news of the heart procedure, I started trying to figure out why a man, committed to physical fitness, at the increasingly “young” age of 67 succumbed to a blockage, while also trying to balance the idea that none of us are 100 percent immune to the No. 1 killer of Americans, heart disease.

Like him or not, Bush always set an example for fitness, frequently seen running or biking. Even with the stresses of being president, medical reports listed his resting heart rate in the mid-40s, his body mass index in the lower end of normal, and healthy blood pressure levels.

So why? And what’s the takeaway.

Healthy? Still get checked

Former first lady Laura Bush offered the clearest takeaway. She told the Dallas Morning News that people should have regular check-ups, including women.

“I hope that will be the silver lining, that the word will get out to a lot of people,” said Bush, who’s played a prominent role in the Heart Truth campaign, an effort to raise awareness about heart disease among women.

Local heart experts underscore that while we have learned a lot about how to prevent and treat heart disease, its daily toll should be a reminder that vigilance is key.

Dr. Troy Bunting, medical director of the cardiac catheterization lab at Roper St. Francis Hospital, says that while Bush was considered physically fit, “coronary artery disease accumulates over time and reflects lifelong lifestyle habits.”

“A person may be eating a healthy diet and exercising now, but they may still be at risk for heart disease. Certainly a healthy lifestyle of diet and exercise can prevent further damage,” says Bunting, adding the importance of people talking to their doctor and getting screened, such as an exercise stress test or electrocardiogram.

Bunting adds that President Bush’s heart disease was initially discovered on routine stress testing and, like the former first lady, he hopes the news will raise awareness of screening, symptoms and risk factors.

Why a stent?

Dr. Michael Gold, chief of cardiology at the Medical University of South Carolina, says that while specific details on Bush’s symptoms and blockage have not been released, coronary stents are used to treat severe blockages, defined at 70 percent or more. Stents are effective for reducing symptoms or minimizing the size of heart attacks if one is occurring.

“CAD develops when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on the inner walls of the artery,” says Gold.

“As this buildup or blockage gets more severe, less blood can flow through the arteries. This can lead to chest pain, heart attack or other symptoms. Most heart attacks happen when a blood clot forms on the plaque and suddenly cuts off the heart’s blood supply, causing permanent heart damage.

And atherosclerosis, which leads to the development of CAD, is part of the aging process, Gold says.

‘This can be accelerated by certain risk factors such as high blood pressure, diabetes, high cholesterol, cigarette smoking or a family history of heart attack at a young age,” says Gold, adding that not having risk factors does not protect a patient from developed atherosclerosis.

“ It simply reduces the risk and may delay or slow down the process. Therefore, treating and minimizing these risks are important and prevention is the mainstay for reducing heart attacks and other consequences of atherosclerosis, including regular exercise and a heart healthy diet.

Bush’s unknown factor

And what about diet?

While keeping an ear and an eye out on the Bush story all week, I kept waiting to hear about the one caveat that I could see in his heart health. What was Bush’s diet like?

I wondered about Bush’s diet and, as a Texan, how much red meat was in it. (There are no answers to that question online). And I wondered if, or when, the next time President Clinton talks to President Bush that he may have some post-presidential diet advice, namely eating a plant-based vegan diet.

Famed heart surgeon Caldwell Esselstyn Jr., who has made a convincing pitch for a vegan diet in the documentary “Forks Over Knives,” played a role in Clinton’s decision and explained the effects of animal and processed foods in a Q&A in Jan. 30 edition of the Chicago Tribune.

Esselstyn explained that endothelial cells, which line the interior surface of our blood and lymphatic vessels, pump out “marvelous amounts” of the free radical nitric oxide, or what he calls “the absolute guardian and life jacket of our vessels.”

“Nitric oxide keeps cells within our blood vessels flowing smoothly like Teflon, rather than Velcro. Nitric oxide also prevents inflammation from developing in the walls of the arteries, keeps us from getting stiff vessels and has a role in keeping us from developing blockages or plaque.

“Every time we ingest certain foods, it compromises and injures the endothelial cell’s capacity to make nitric oxide. As we are constantly getting less and less nitric oxide, we are less able to prevent coronary artery disease.

Those certain foods? Esselstyn says, “Animal and processed foods, primarily oil, dairy, anything with mother or face — meat, fish and fowl — and sugar, coffee with caffeine.”

Tweaking the plan

There’s no telling if Bush needs to make changes, or if he does, whether he will.

But Dr. Suzanne Stein- baum, spokeswoman for the American Heart Asso- ciation and a cardiologist at Lenox Hill Hospital in New York City, told U.S. News & World Report that he should.

“The stent allows for blood flow through the artery but is not a cure for atherosclerosis. Although a relatively simple procedure, it is more like a Band-Aid then an overall solution,” says Steinbaum.

“Blockages of the artery, or atherosclerosis, develop from high blood pressure, high cholesterol, diabetes, smoking, stress, sedentary lifestyle and family history. His job now will be to modify those risk factors to keep all of them in check. ... The next phase is prevention through healthy lifestyle choices, through diet, managing stress and continued exercise.”

And while there is no bullet-proof vest against heart disease, there are always more we can do to improve our odds of surviving, from routine check-ups to eating a plant-based diet.

Reach David Quick at 937-5516 or dquick@postand courier.com.