HEALTH / Second Opinion

THE DEATH of Labour Party leader John Smith has put coronary heart disease under the spotlight and renewed concern about the stress under which politicians work. No doubt there are good arguments for reforming the old-fashioned working rituals of the House of Commons, but fears about the health of MPs have very little basis in fact. Politicians, like men and women in other occupations, recover from heart attacks and go back to top positions. One of the best- known examples was Lyndon Johnson, who suffered a severe coronary thrombosis before he became President of the United States and maintained a punishing schedule during his term in office.

Many people who survive a heart attack make a good recovery; a few, like John Smith, are unfortunate. The figures show that about 20 per cent of people who suffer a heart attack die within a few hours, another 10 per cent die within the next four weeks. But of those who survive the first year - around two-thirds of the total - more than half are still alive 10 years later. These are better chances than those offered by treatment of most common cancers.

Nor is there much evidence that a politician's lifestyle is unusually stressful. MPs have the same life expectancy as any group of middle- to old-aged men who drink and smoke too much. Stress can be bad for the heart but for the workaholic who enjoys his high-pressure lifestyle it seems to do little harm to his health. It is middle managers and blue-collar workers, not their bosses, who suffer from stress-related illnesses.

The chances of long-term survival after a heart attack have improved substantially over the past 20 years. The crucial message is that by far the greatest risk is in the first hour or two - before the victim reaches a hospital with a coronary care unit. Delay at this stage may be fatal: someone whose heart stops outside hospital has a much lower chance of recovery than someone whose symptoms have caused them to seek specialist care before the crisis occurs. Furthermore, if clot-busting drugs can be given within an hour or two of the first symptoms of chest pain, the damage to the heart muscle will be kept to a minimum.

After discharge from hospital people who have recovered from heart attacks are brought back for reassessment, when tests are done on the heart and circulation during exercise. If one or more of the coronary arteries is narrowed, surgery may be recommended - either the simpler angioplasty procedure or full-scale coronary artery bypass surgery. Long-term drug treatment will often be prescribed, since clinical trials have shown that in many cases such treatment significantly improves survival figures.

All too often the problem for the survivor is that he or she feels so well that the crucial changes recommended to lifestyle are gradually forgotten. It is easy to slip back into smoking, the low-fat diet may seem boring, and it may be difficult to find the time for regular exercise. Long-term recovery is a long haul. However, the sad death of a leading politician should not lead to the mistaken belief that survivors of heart attacks are invalids who should be protected from the demands of challenging work.