Former President George W. Bush is expected to leave the hospital tomorrow (Aug. 7) after undergoing a stent procedure to open up a blocked artery in his heart today. Doctors discovered the potentially life-threatening condition during a routine physical through a procedure called a stress test. After the surgery, the 67-year-old was "in high spirits, eager to return home tomorrow and resume his normal schedule on Thursday," spokesman Freddy Ford said. 

While several factors can influence heart disease, including high blood pressure, high cholesterol, smoking, stress and family history, Bush's stent is still surprising considering his active lifestyle. Known as a "fitness nut" during his two terms in the White House, he's since participated three times in the 100-kilometer (62-mile) Warrior 100K charity bike ride. As Reuters notes, he was also named by the website AskTheTrainer.com the most physically fit president in U.S. history.

"His physicians classified him in the top 2% of men his age for cardiovascular fitness," the site reported in 2008. "He went 26 minutes on a treadmill test (protocol unnamed), attaining a heart rate of 178 beats per minute. Bush's resting heart rate was 43 beats/minute, and his blood pressure 118/74 mmHg. His total cholesterol level was 170 mg/dl."

All this and he still had a blocked artery? What gives? According to famed heart surgeon Caldwell Esselstyn Jr., Bush's problem may not be so much his lifestyle as it is his diet. 

"They say risk factors are diabetes, high blood pressure, smoking and maybe too much saturated fat. But when you really come down to it, food trumps them all," he told the Chicago Tribune earlier this year

Esselstyn goes on to explain that the endothelial cells, which line the interior suraface of our blood and lymphatic vessels, pump out "marvelous amounts" of the free radical nitric oxide. Calling it "the absolute guardian and life jacket of our vessels," nitric oxide keeps the cell walls flowing smoothly and helps prevent infallmation, stiffness, and other factors that lead to blockages or plaque.

"Every time we ingest certain foods, it compromises and injures the endothelial cell's capacity to make nitric oxide. As we are constantly getting less and less nitric oxide, we are less able to prevent coronary artery disease."

Esselstyn counts animal and processed foods -"anything with a mother or face" - as well as sugar and coffee with caffeine as those "certain foods" that restrict our ability to create nitric oxide. The replacement food is all leafy greens and whole grains - and no oils.

"The last thing you need is oil. You never need it. It injures the endothelial lining," he adds. 

While such a diet may seem tough to immediately shift to, Bush can at least take solace in knowing that another former president has managed just fine - and with amazing results.

Back in 2010, following a stent procedure to unclog a blocked artery (he had previously undergone a quadruple-bypass in 2004), Bill Clinton decided to pursue a plant-based diet. Along with Dr. Esselstyn's book "Prevent and Reverse Heart Disease," Clinton also educated himself with Dr. Dean Ornish's "Program for Reversing Heart Disease" and biochemist T. Colin Campbell's "The China Study."

"I'm trying to be one of those experimenters," Clinton said after making his new diet public. "Since 1986, several hundred people who have tried essentially a plant-based diet, not ingesting any cholesterol from any source, has seen their bodies start to heal themselves — break up the arterial blockage, break up the calcium deposits around the heart. 82 percent of the people who have done this have had this result, so I want to see if I can be one of them."

In the three years since making the switch, Clinton has lost more than 30 pounds and increased his exercise - walking two-three miles a day and enjoying sports such as golf. 

The AARP recently highlighted Clinton's typical daily menu saying, "For Bill Clinton, breakfast is almost always an almond-milk smoothie, blended with fresh berries, nondairy protein powder and a chunk of ice. Lunch is usually some combo of green salad and beans. He snacks on nuts — "those are good fats" — or hummus with raw vegetables, while dinner often includes quinoa, the Incan super-grain, or sometimes a veggie burger."

Whether Bush decides to embrace a plant-based eating plan or not - it's clear that some changes independet of his fitness routine will have to be made. 

"Lifestyle choices, such as diet and exercise, will be a part of this regimen as well as medications," Dr. Suzanne Steinbaum, spokeswoman for the American Heart Association and a cardiologist at Lenox Hill Hospital in New York City told US News. "The stent allows for blood flow through the artery, but is not a cure for atherosclerosis. Although a relatively simple procedure, it is more like a Band-Aid then an overall solution. The next phase is prevention through healthy lifestyle choices, through diet, managing stress and continued exercise."

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