Theoretically, if a patient had "perfect care," was handling stress, diet, and exercise and still had a recurrence of blockage, the cause could be partly genetic, says Dr. Randal Thomas, director of the Mayo Clinic Cardiovascular Health Clinic and president of the American Association of Cardiovascular and Pulmonary Rehabilitation. But in Clinton's case, he says he'd be "surprised if it were all genetic."
Thomas says studies show that patients can further lower their risk if they "adjust treatment with medication to be even more aggressive, have even lower targets for cholesterol, and really ratchet up the intensity of therapy."
This therapy includes the ABCs of heart disease, Thomas says: aspirin, beta blockers (to lower blood pressure), cholesterol medication (usually statins), diet, exercise, and fish oil.
For someone with coronary artery disease, Hayes says -- which Clinton's "got it in spades" -- statins play a key role in post-op care. "Current guidelines say [these patients] should be on statins indefinitely."
But according to a report from the New York Times, while Clinton had been on the statin Zocor to lower his cholesterol before his 2004 surgery, he did not remain on it.
Whether it's medication management, stress, or genetics at the root of Clinton's arterial blockages, cardiologists say that Clinton should go into cardiac rehabilitation -- a program of education, monitoring, and cardiac care -- in order to unearth exactly what needs to change.
"After a stent procedure," Hayes says, "[rehab] has been shown to decrease risk of a patient coming back with a heart attack. It's an underappreciated, very underutilized [tool]."
Cardiac rehabilitation is a comprehensive program that provides patients with emotional support, education about lifestyle, and supervised exercise training, as often, even previously active patients are fearful of working out after a cardiac event.
These programs reduce mortality following a cardiac event by 25 to 35 percent, Thomas says.
But this therapy is time-consuming: programs generally consist of three hours of monitored exercise and three hours of group sessions a week, Thomas says -- a time commitment that may be hard to squeeze into the former president's booked-solid schedule.
"I would hope that [Clinton] finds some time to continue the care that's going to help [his heart]," Hayes says.
But coronary artery disease is a lifetime commitment, Thomas says. "[Surgery] is a good short-term solution [but] it's temporary; in the long term, the most powerful thing we can do is adjust lifestyle and medication.
"Unless we get rid of the underlying problems," he says, the problem will come back.