We are all saddened by the untimely and sudden death of Tim Russert, a true American legend. Russert's fatal cardiac arrest was particularly surprising because he had very few risk factors for heart disease: He did not drink or smoke, he paid attention to his diet, exercised and had just taken a vacation. Even more alarming, Russert had a normal stress test just a few weeks ago. Now Americans everywhere are seriously confounded — how is it that you can do all the right things and still have a heart attack?

Even with a healthy body, there is no lifetime guarantee. You can eat right, exercise and live a teetotaler lifestyle and still be struck down by a sudden, surprising and out-of-the-blue heart attack. Stress tests and CT scans to identify coronary artery disease do not predict sudden cardiac arrest. All we really know is that increased awareness and living a heart-healthy lifestyle can dramatically decrease your risk of cardiac arrest.

Sudden cardiac arrest occurs because of an acute blockage of a blood vessel supplying a small area of the heart. This makes the heart muscle hyper-irritable, leading to an uncontrollable electrical impulse that rapidly increases the rate and regularity at which the ventricle beats. As a consequence, no blood is pumped into the aorta, and within seconds the patient is comatose. Cardiopulmonary resuscitation, immediate access to a defibrillator, and the use of certain medications can return the heartbeat to normal in a fraction of cases. Although Russert received immediate attention, it was ineffective.

Who is at increased risk? Sudden cardiac arrest occurs most frequently in men between the ages of 58 and 62. It is more common in those with a strong family history of heart disease, those who lead stressful lives, and in anyone who has had a heart attack, has evidence of coronary artery disease or is at high risk of having a heart attack. This includes elevated cholesterol, high blood pressure, diabetes, poor diet and a sedentary lifestyle.

Most importantly, cigarette smoking increases the risk of a heart attack and, if an attack occurs, the risk of sudden death is fourfold higher. Sudden cardiac arrest can also occur because of an abnormality of the electrical conduction system that controls the heart rhythm. This is usually the cause of sudden death in young adults and in athletes.

Based upon these facts, it is important that by age 20 every adult be screened for elevated cholesterol and high blood pressure and learns the importance of diet, exercise and stress in preventing heart disease. For individuals with a strong family history of elevated cholesterol, heart disease can be seen at a young age. Anyone who has a history of an irregular heart rate or palpitations should see a doctor and be examined to exclude a heart murmur and should have an electrocardiogram to identify any problems with the cardiac conduction system that can lead to irregular heart rates. Medications can reduce the risk of sudden cardiac arrest.

In general, cholesterol should be measured every 10 years until age 50 and more frequently thereafter. Blood pressure should be monitored at least four times a year (the supermarket is a good place), and symptoms of chest discomfort should never be ignored. People who have a large number of risk factors should have an EKG and a stress test at age 50.

If an abnormality is identified, be wary of considering an angioplasty or open-heart surgery, as there is essentially no evidence that life expectancy can be prolonged or heart attacks prevented in totally asymptomatic individuals. Screening for and treating diabetes, if found, and for smokers, entering a smoking cessation program, are very important.

If you have coronary artery disease, it is critical that treatment to prevent a heart attack and sudden death be implemented. This includes lowering the bad, or LDL, cholesterol to below 70, maintaining the systolic, or top, blood pressure below 130, and taking medications (beta blocker and ACE inhibitor) that decrease the risk of heart attack and help prevent irregular cardiac beats. In some patients an implantable defibrillator may be recommended. Finally, remember, a heart-healthy lifestyle from a young age is the key to preventing sudden death and assuring a long and independent life.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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