Republican Sen. John McCain, who would be the oldest first-term president ever sworn in if he wins his White House bid this year, is in "excellent physical and mental health," the leader of his medical team said Friday.
"We can find nothing in his medical history that would preclude him from serving as president of the United States with vigor," Dr. John Eckstein, who serves as McCain's primary care physician at the Mayo Clinic in Scottsdale, Ariz., told reporters.
Eckstein and other Mayo physicians involved in McCain's care spoke with reporters after the Arizona lawmaker released 1,173 pages of medical records. Campaign spokeswoman Jill Hazelbaker said the extent of McCain's disclosure is "unprecedented in the history of presidential campaigns."
Neither of the Democratic presidential candidates — senators Barack Obama, D-Ill., or Hillary Rodham Clinton, D-N.Y. — have released health records.
McCain's documents provide minute personal details about the senator's medical history, ranging from his battle with melanoma to a bout of skin fungus. The senator takes medications to lower cholesterol, prevent kidney stones, and, when he's traveling, to sleep.
McCain, who turns 72 on Aug. 29, frequently jokes about his age. He also points out that his 96-year-old mother, Roberta, still trots the globe with her twin sister.
The senator's medical records indicate that his most serious problem has been recurring skin cancer. He had four malignant melanomas — the most dangerous type of skin cancer — removed between 1993 and 2002. One involved a five-hour operation that left what surgeon Michael Hinni described as "a fairly sizeable wound" on the senator's left jaw.
Surgeons repaired the wound by moving skin on McCain's face, but made several subsequent efforts to reduce the swelling, which still can give the senator the appearance of a ballplayer with a wad of tobacco in his cheek. According to the medical reports, the doctors seemed more bothered than the senator by the cosmetic problem. "He is not considering other therapies or operations to correct this," Hinni noted after a 2001 visit.
McCain returns for checkups with Mayo Clinic dermatologist Suzanne Connolly every three to four months. "She watches him like a hawk," Eckstein said. McCain's doctors said the fact that no new melanomas have been discovered is a good sign.
One outside expert agrees. Although the senator remains at high risk for additional melanomas, these types of skin cancers can usually be found early enough to be easily treated, posing little risk of death, says Martin Weinstock, a professor of dermatology and community health at Brown University.
While melanoma can return at any time, it's most likely to return within a few years of surgery, says Suzanne Connolly, McCain's dermatologist. She said doctors found a small squamous cell cancer — a common type that isn't life-threatening — on his leg in February.
A man of McCain's age is probably at greater risk of death from causes other than skin cancer, Weinstock said.
McCain's doctors say he is in good cardiovascular health. A cardiologist at Brigham and Women's Hospital in Boston and an associate professor at Harvard Medical School, Christopher Cannon, not a member of McCain's medical team, says McCain has a 22% risk of a heart attack or death in the next decade, based on data from the Framingham Heart Study. Doctors routinely use the study to calculate risk.
Eckstein, an internal medicine specialist who has treated McCain for 16 years, says there's no medical reason why McCain shouldn't be able to fulfill all the duties of president. Eckstein says McCain has "no evidence" of heart disease or other cardiovascular problems, has normal blood flow to his heart muscle and even walked the length of the Grand Canyon two years ago.
The records released Friday show that McCain stopped smoking in 1980 after smoking two packs a day for 25 years. The senator wrote about his youthful drinking exploits in his memoir Faith of My Fathers— including one episode where he fell through the screen door of a girlfriend's house after too many beers. Today, his alcohol intake is "very infrequent: two drinks per month," according to a note Eckstein made after McCain had a physical earlier this year.
Eckstein said in a press conference that he has advised McCain to decrease his salt intake, but said the senator does not have high blood pressure.
Cannon says three of McCain's risk factors are reasons for concern:
• Although McCain is at a healthy weight — 5 feet, 9 inches tall and 163 pounds — the senator's blood pressure, 134 over 84, qualifies him as a "prehypertensive." That's higher than ideal, but below the cutoff for high blood pressure, Cannon says.
• Eckstein said he recently doubled McCain's dose of a drug called hydrochlorothiazide to treat kidney stones. But Cannon notes that this drug is also a diuretic and is commonly used as a first-choice treatment for blood pressure. If McCain needs the diuretic for his blood pressure, that would increase his heart risk even more, Cannon says.
• Cannon says McCain's cholesterol should be lower, given the candidate's blood pressure. McCain's total cholesterol is 192 on a scale in which anything below 200 is considered healthy. His LDL, or "bad cholesterol," is 123, while his HDL, or "good cholesterol," is 42. According to national guidelines, a man with McCain's other risk factors should have LDL of less than 100 and, ideally, no more than 70, Cannon says.
McCain, who had been taking an anti-cholesterol drug called Vytorin, recently switched to another statin, called simvastatin, after studies raised concerns about Vytorin's effectiveness. Although McCain got good scores on a stress test, Cannon said the senator's high blood pressure and cholesterol are more important indicators of his risk of a heart attack.