I do have anecdotal evidence of acute MI in young patients taking Chantix. I believe the Govmnt of Denmark is looking into this, any scientific evidence?

You mentioned "work stress" as a contributor to Tim Russert's plaque rupture and sudden death.

Given we are all under "work stress" on a daily basis do you think that his obesity was the overwhelming cause of his myocardial infarction, and perhaps too much attention is given to stress as a cause of myocardial infarction.

"Work stress" seems to be the excuse people use for the cause of myocardial infarction when other well documted risk factors seem to be predominant. I would appreciate your thoughts, thanks for your time.

From an Emergency Medicine perspective....

Apparently an AED on-site, but paramedics arrived before it was used - why the delay in AED use?

Bystander was attempting ventilation, but NO chest compressions being performed - obviously AHA scientific advisory on the importance of chest compressions has not been disseminated enough.

Sounds like he received only 3 defibrillations and ~15 minutes of on-scene treatment before transport to the hospital. Not very aggressive EMS care for a witnessed cardiac arrest (unless he had ROSC that hasn't been reported). AHA recommends pt NOT be moved while CPR in progress.

Very sad........................

 I viewed your comments on the cease and desist order by California on genomic providers. Has the world not figured out that most if not all serious side effects of FDA approved drugs are genetically determined?  How will we ever learn who may safely use effective drugs if the means to determine their safety is barred by well meaning individuals who want to prevent charlatans from grabbing our money?  If I want to smoke cigarettes without the fear of contracting lung cancer - should I not be allowed to get the genetic test to show if that is the case?  The medical community rightly should prevent dangerous practices from continuing. Many may think that genomics is a waste of money and not effective or even provide mis-information but that is little reason to prevent those who think otherwise to continue to provide this service.  If we tried to eliminate all the  medical practices that have not been proven to be effective - we would have very little left. Thanks for your commentary - I agree.

I have noted many patients coming in spooked by this person's death.  Bill Clinton was nearby a physician while in the Oval Office for 8 years, but we didn't get to him until he needed bypass surgery.  No accusations of individuals caring for him or for Tim Russert, but it does remind me that heart and vascular disease is still the leading cause of death in this country, that many still die of SCD before getting to the hospital, and there is some factor that is either randomness or something we are not measuring that explains your statement, Eric, that "With all the diabesity and stress out there, acute MIs are relatively rare..."

It also impresses me that even with appropriate treatment, the majority of people that would have had events still have them -- that is, if you have a treatment that lowers the MI rate 30-40%, that means that 60% will still have the event despite treatment!   Looking at it the other way, for primary prevention, treating someone with hypercholesterolemia changes their chance of NOT having an MI from 96% (estimate) to somewhere in the 97.5% range in the few year study period--  makes all of our efforts seem less impressive...

Don't worry -  I'm still advocating treating to ACC/NCEP/AHA goals, but I explain these realities to my patients.