John Hughes' Heart Attack May Have Had No Warning

A heart attack is often the first symptom of heart disease.

August 7, 2009, 5:42 PM

Aug. 8, 2009 — -- A sudden heart attack Thursday claimed the life of writer and director John Hughes, whose iconic, teen-driven films included "Ferris Bueller's Day Off," "The Breakfast Club" and "Some Kind of Wonderful," and launched the careers of "Brat Pack" members such as Molly Ringwald and Emilio Estevez.

Hughes, 59, had been in Manhattan visiting family when he had the fatal heart attack during a morning walk, according to family spokeswoman Michelle Bega.

More than 1 million cases of new and recurrent heart attacks occur each year in the U.S. and they are responsible for one out of every five deaths, according to the National Heart, Lung, and Blood Institute.

Unfortunately, heart attacks in real life are not always as dramatically heart-clutching as they are in the movies. For many, a heart attack may be the first sign that they have heart problems.

"The problem with sudden cardiac death is that, of all the people that have heart disease ... half of the time the first symptom is a heart attack," said Dr. Stephen Kopecky, professor of medicine and a cardiologist at the Mayo Clinic in Rochester, Minn. "And half of that, half will [die] within an hour."

These cases lack any of the classic warning signs of a heart attack, such as chest pains, shortness of breath or nausea, which can signal a problem that needs medical attention.

"You never even get a chance to go back and re-do or correct the risk factors," said Dr. Clyde Yancy, medical director of the Baylor Heart and Vascular Institute at Baylor University Medical Center in Dallas. "That means that the time to [control them] is not during the first episode of shortness of breath or chest discomfort, it's now."

Bega said no information about Hughes' medical history is being released at this time, but according to the American Heart Association, the most important risk factors for developing heart disease, which could lead to a heart attack, include smoking, a family history of heart disease, high cholesterol, hypertension and diabetes.

The biggest danger posed by these and other risk factors -- there are more than 200 known risk factors for heart disease -- is damage to the lining in blood vessels.

Hughes' Death May Highlight Risk of Heart Disease

While it is true that narrowed arteries from plaque buildup or hardening is a significant risk factor for heart attack, blood clots that form when the arterial lining gets ripped or torn are a more common problem, Kopecky said. These clots can stop up a blood vessel like a cork in a bottle, leading to a heart attack.

"They really come out of the blue," he said.

But prevention strategies are simple. One study from the National Institutes of Health found that not smoking, controlling weight and body fat, eating five servings of fruits and vegetables each day, and exercising vigorously each week could cut a person's risk of having a fatal heart attack or stroke by up to 90 percent, depending on how early in life they began a healthy regime.

"The sad thing is that of all American adults, only 3 percent do all four of those things," Kopecky said.

Yancy said that Hughes' death may highlight how acute the risk of heart disease can be, but that a negative approach regarding heart attack is unnecessary.

"We have to recognize that there is no need to take a doom and gloom approach here," Yancy said, noting the importance of awareness and education about good treatment options for people at all points of the risk spectrum.

"It's so evident that a lot of the risk is modifiable," he added. "For many people, the reason for hesitancy is fear, but that is not the case and there is a lot that can be done to mitigate risk and improve outcomes. After you get started, it all flows together."

Better screening and detection techniques for risk factors, such as imaging calcium deposits in blood vessels, could help head off heart problems before they begin. In addition, Yancy said genetic medicine holds huge promise to identify those at risk for atherosclerosis -- hardened arteries -- and other indicators of heart disease, which may help prevent fatal heart attacks and strokes.

But these techniques are many years away from common use. Significant lifestyle changes remain the best way to prevent heart disease and reduce the risk of sudden heart attack.

"This is a scary problem and it really is the way that the majority of people in this country die," Kopecky said. "We can't let ourselves get fooled into thinking you'll have some warning."

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