The death of Tim Russert is teaching us a lot about the mechanics of sudden heart attack.
First, we're all right to be paranoid. There are roughly 1.2 million heart attacks a year in the U.S., over one third of them fatal. About 300,000 victims die suddenly and half, like Russert, have no symptoms.
The most likely cause in these cases are plaques that build up outside the walls of coronary arteries, like pimples, as opposed to those which build on the inside walls, causing blockage and pain.
We can deal with those inside-wall plaques using stents and bypasses. But you can't operate on what you don't know is there.
In Russert's case one of these heart pimples popped, or ruptured. This cascaded into an abnormal heart rhythm that might have been adjusted with a defibrillator, but Russert was at his desk and none was available.
Only after Russert died, under autopsy, did doctors find he had a lot of these plaques. Standard tests had found very little wrong.
There were warning signs, however.
Russert was overweight. He had a high calcium score. An EKG in April showed some muscle thickening, his ability to exercise slightly reduced. But that could be age, his medication was changed, he was trying to lose the gut.
Contrast Russert's death with that of my friend Russell Shaw. He had a different set of risk factors, some involving blood sugar. He died in his sleep, being (unlike Russert) unfamiliar with the markers of his condition.
Some say if you're going to go from a heart attack, go the way George Carlin did yesterday.
Carlin didn't have Russert's weight problem, but he had a long history of heart trouble, perhaps exacerbated by a history of illegal drug use.
While Russert died at work, and Russell Shaw in a hotel, Carlin died in a hospital. He went there the day before his passing when he felt pain. He knew what was coming for some time, but seeing the train in front of you doesn't help you get off the track.
What does all this teach us? Lose the weight, lose all the cigarettes, beware of any heart changes at any age, keep giving money for active studies of heart health, but remember that no one gets out of this life alive.
Or no one has so far.