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Power Diet Shoes"Jim Fixx had multivessel coronary disease he couldn't do anythingabout, no matter how many veggies he ate or miles he ran," Califfsays. "Wearing a seat belt doesn't guarantee you aren't going toget killed in a car crash." Russert's death is a wake-up call to thousands of men who neverthought they might be courting a coronary, says Cam Patterson,chief of cardiology at the University of North Carolina-ChapelHill. "You wouldn't believe the calls we've been getting," Pattersonsays. "Here's an example of a high-profile person who everyonethought was healthy. When someone like that has a medicalcatastrophe, it causes everyone to focus." Warning signs Both men had ample warning they were prime candidates for heartattacks. Russert had been diagnosed with coronary artery disease,his doctor told MSNBC. Fixx had a terrifying family history,including a father who had a fatal heart attack in his early 40s. And both took steps to reduce their odds of the same fate.Russert's doctor, Michael Newman, prescribed medication andexercise. He told MSNBC that Russert performed well on a stresstest in April. Fixx, who reached the height of his fame beforecholesterol-lowering drugs were widely available, changed his diet,laced up his running shoes and ate up the miles. Russert's death seemed all the more shocking for the era in whichit occurred, one of rising optimism about potentcholesterol-lowering drugs and decreasing death rates from heartdisease. Just over a year ago, a team led by researchers at the Centers forDisease Control and Prevention reported that the death rate fromheart disease in the USA has dropped by 50% from 1980 to 2000,thanks to improvements in medical treatment and a reduction in riskfactors. The researchers credited those advances — including intensivecholesterol-lowering and blood pressure control for heart attackpatients and a drop in smoking rates — with saving anestimated 341,000 lives that would have been lost to heart diseaseif conditions in 1980 had persisted. For all those advances, however, medical science still has nodefinitive way to tell in a given individual when "something's justaround the corner," says cardiologist Sidney Smith at UNC. Thedifferent tests at doctors' fingertips provide varying amounts ofinformation but not, typically, what doctors and patients most wantto know. For instance, a routine stress test, performed using a combinationof a treadmill and electrocardiogram, can disclose heart rhythmabnormalities that occur during exercise when blockages prevent theheart's blood supply from meeting its growing demand. Nuclear andultrasound stress tests produce cloudy images and information onheart function. CT heart scans, a series of rapid-fire X-rays,reveal calcified blockages in the coronary arteries. None revealsan imminent heart attack. The best indicators, Califf says, are standard risk factors forheart disease: blood pressure, cholesterol, smoking, diabetes,stress, diet, exercise and abdominal obesity. Reliable, not perfect, data Plugged into a formula called the Framingham Risk Score, the riskfactors provide reliable odds of a person's heart attack risk. Theodds are derived from real world experience — an ongoing,60-year-old heart study among thousands of residents of Framingham,Mass. But the Framingham score is imperfect, too. Half of all heartattacks occur in people who have no risk factors and 20% in peoplewith no major risk factors. The reason lies in the biology of the coronary artery. In landmarkresearch, Steven Nissen of the Cleveland Clinic has shown that whencholesterol begins collecting in artery walls, it pushes themoutward, not into the channel where blood flows. So many patients— Russert included — experience no symptoms of heartdisease. Heart attacks occur when a plaque becomes inflamed and bursts,sending blood clots and debris downstream to lodge in arteriessupplying the heart. Standard diagnostic tests don't reveal theseinflamed cholesterol deposits or plaques. Over the past few years,researchers led by Paul Ridker of Harvard have shown that testingfor a chemical signal of inflammation, called C-reactive protein,or CRP, can add predictive power. But many heart attacks are still unpredictable. Russert's is atextbook example. Making positive changes UNC's Patterson says allowing fatalism to grow out of theuncertainty is the wrong thing to do, because you can dramaticallyreduce the odds that you'll be next by reducing the risk factors. "I try to eat well, avoid fatty foods, eat seafood a couple oftimes a week," he says. "I don't smoke. I have a regular exerciseregimen. I run three or four times a week. I try to build it intomy lifestyle." Not making such practices a permanent change is "a big mistakepeople make," he says. "It needs to be the thing you do on a dailybasis. "If there's one key message I try to get home to people, it'sthis," Patterson says. "There's great news. Over the last 30 years,we've substantially reduced deaths from heart disease in the U.S. "But it's still the leading cause of deaths and disability. Halfthe people who are walking around are going to die at some point ofheart disease."