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CNN Larry King Live

Encore Presentation: Surviving Heart Disease

Aired February 11, 2006 - 21:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

LARRY KING, CNN HOST: Tonight, surviving heart disease, one of America's deadliest killers striking young and old, men and women. With us Patty Duke, the legendary actress had bypass surgery just over a year ago; Kate Jackson, the "Charlie's Angels" star underwent open heart surgery to fix a life threatening defect that she never knew she had; Jennie Garth of "Beverly Hills 90210" fame, riding an emotional roller coaster with her dad who's had five open heart surgeries; renowned cardiologist Dr. P. K. Shah and Dr. Arthur Agatston, the cardiologist and author of the best-selling "South Beach Diet." What they know could save your life.
It's next on LARRY KING LIVE.

I'm wearing a red tie tonight for a good reason. This is National Wear Red Day or Go Red as it's called. Laura Bush has been spearheading this to encourage people to take an interest in women and heart disease. As it happens, we have three women associated with it tonight as our guests, Patty Duke, Jenny Garth and Kate Jackson.

Let's start with our doctors though. We've got lots of interesting stuff coming this evening as we look at heart disease. Is it true, Dr. Shah that we've generally looked at heart disease in the past as male?

DR. P. K. SHAH, INTERNATIONALLY RENOWNED CARDIOLOGIST: That's absolutely correct, Larry. Until very recently people didn't recognize the fact that heart disease is an equal opportunity killer of men and women.

And it's only in the last few years that as the awareness has increased that women have begun to recognize the fact that what kills most women is heart disease and yet they used to fear breast cancer the most but cancer is not the leading killer of men or women. It's heart disease.

KING: Why was it not emphasized, Dr. Agatston?

DR. ARTHUR AGATSTON, CARDIOLOGIST, AUTHOR "THE SOUTH BEACH DIET": Well, women developed heart disease later than men and that was -- that was one of the feelings that more young men were dying of heart attacks than women but soon after menopause women begin to catch up.

They also often don't present like men do. They're more likely to not have typical chest pain. They have more shortness of breath, sweating and some dizziness and for that reason sometimes their heart disease was missed.

KING: Did doctors tend, Dr. Shah, frankly to dismiss them?

SHAH: Well, I say that women had three strikes against them. First they were never aware that they were at risk and so they didn't believe their own symptoms. Their spouses would often dismiss them as well and would not believe that they could be having heart problems. And their physicians dismissed their symptoms as well.

So, because of this, I think often the diagnosis of heart disease was made later in women than in men and sometimes not even made until they had a catastrophic complication like a massive heart attack or stroke.

KING: By the way, Dr. Agatston it's interesting to learn, we learned before the show, studied under Dr. Shah is that right?

AGATSTON: Yes, he was -- his great lectures actually influenced me to go into cardiology.

KING: So you're partially responsible for the success of this book P. K.

SHAH: Well, I hope he shares that with me, just kidding Arthur.

KING: Patty Duke what's...

AGATSTON: We'll negotiate after the show.

SHAH: OK, OK.

KING: Patty Duke, what's your story? What happened?

PATTY DUKE, ACTRESS: My story is that for a couple of years I was having some blockages in my arteries and they were taken care of very well by stents.

KING: Angioplasty?

DUKE: Yes and then there came the moment where we'd done enough stents and it was time to do open heart surgery in order to fix the right coronary artery. And, it's funny, you know, you don't -- you don't know how you're going to react until a doctor tells you that.

And, I of course always want to be real cool. I was real cool with a quivering lip and terrified, utterly terrified. Do you know right after the surgery, I mean it hurt, there were things that hurt but I felt better up here.

KING: Me too.

DUKE: I really did. You know that feeling?

KING: Oh, I was scared, nothing scarier than facing...

DUKE: Yes.

KING: Are you aware of that Dr. Shah? SHAH: Oh, absolutely.

KING: That the patient is scared to death?

SHAH: Absolutely, absolutely. In fact, people have recorded conversations with patients prior to surgery and then after surgery and compared and there's a big difference in how patients perceived going in as well as coming out, what a big difference, very scary even though they may be very stoic and deny it but when you really, really question them it is a scary moment to go under the gun, under the knife.

KING: Jennie, yours has been in the family, right? You don't have heart disease?

JENNIE GARTH, ACTRESS: No, I don't have heart disease.

DUKE: Knock on wood.

GARTH: Yes, please. My father suffered his first heart attack when I was nine and has been battling heart disease for the last 26 years.

KING: Other heart attacks after that?

GARTH: Yes, he actually had I think four or five open heart surgeries and is now in the throws of congestive heart failure as a result of a damaged heart muscle.

KING: How old?

GARTH: He is 73 but he will not give up. He just keeps rattling. Every time I think that he's going downhill he comes back stronger than ever because he has such a great will to live.

DUKE: He's the inspiration for the rest of us.

GARTH: Yes.

DUKE: I mean...

KING: Are you concerned about yourself since you probably have the gene?

GARTH: Definitely. I mean I was grilling Dr. Shah in the Green Room. He said if you recommended him, by the way, he would be my cardiologist should I need one.

KING: I'll recommend.

GARTH: OK, good.

DUKE: Not bad.

GARTH: Yes, it's something I definitely think about and especially with my work with the American Heart Association and the Go Red for Women campaign. I've really become sort of ultra sensitive and thinking about going and getting some tests done.

KING: We'll get to it. It's a good idea. We'll get to all that. Now, Kate, you had what a hole in your heart?

KATE JACKSON, ACTRESS: I had an ASD, an Atrial Septal Defect, which is a hole in my heart and...

KING: How did you pick that up? I mean how did they pick it up?

JACKSON: Jerry Pohost, Dr. Gerald Pohost, who is the head of cardiology at S.C. now was in Alabama at UAB when my mom lived down there and I was coming home from doing a television movie and I just didn't feel very good and we'd been doing night shootings so I'd been up all night and trying to sleep in the day.

And, I got home to visit and I couldn't sleep in the night, couldn't sleep in the day and I really felt terrible. And I called him and said, "Jerry, I just don't feel good. I think I belong in the hospital."

And he arranged for me to have a bed and they all fussed over me and he was leaving, walking toward the door, I can see it in my mind, and he said, "Well, I am a cardiologist" and he turned around and said, "I might as well listen to your heart" and he heard it with a stethoscope.

And, I hadn't been a stranger to doctors and it had been missed on EKGs and on all sorts of things. So, the next day they sent in the, what's the machine?

DUKE: Ultrasound.

JACKSON: Ultrasound machine and I had an MRI and they did the EKG and they confirmed his diagnosis that I had an ASD.

KING: How did they miss it, P. K.?

SHAH: Well, this is a hole in the heart that you're born with between the two upper chambers of the heart and it produces very subtle findings that an experienced cardiologist can listen to and suspect it. But a casual observer or a casual physician may completely miss it.

Luckily, it's very easy to confirm the diagnosis with a simple non-invasive echocardiogram, ultrasound of the heart. And, unlike what Kate had, she had a surgical closure of the hole. Nowadays, we don't do surgery for these holes.

KING: What do you do?

SHAH: We fix them non-surgically using a special catheter that you thread through the groin under local anesthesia and at the end of the catheter you deploy an umbrella-like device that you push across the hole and pull back and it deploys and closes the hole non- surgically. It takes an hour or two and we do it day in and day out, so you're home the next day. You take aspirin and Plavix for a few months and you're done.

KING: Dr. Agatston, how rapid are these advances?

AGATSTON: Well, they've been -- they're really accelerating as we speak and I think one of the important messages is that cardiologists and internists around the country who are practicing aggressive prevention are really not seeing heart attacks in their practices anymore.

There are naturally always exceptions but a lot of the future is now we know how to prevent heart attacks; unfortunately, too many of our resources are oriented toward the end of the process, after somebody has had a heart attack with bypass surgery and stents rather than prevention before.

In New York City recently, there was a "New York Times" story about diabetes prevention clinics and the prevention clinics were doing so well at preventing the complications of diabetes that there were not enough amputations and heart surgeries to pay for the clinics because they don't pay for the prevention and clinics had to close.

KING: Oh.

AGATSTON: So, we have to concentrate more on prevention.

KING: We'll take a break and come right back with more. Our entire program tonight devoted to Go Red, the women campaign of National Wear Red Day to focus alert on women and heart disease. Don't go away.

(BEGIN VIDEO CLIP)

JACLYN SMITH, ACTRESS: Please join me and the American Heart Association as we carry a strong message to women across America. Cardiovascular disease is our disease too. Let's do something about it.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

KING: Just one personal note, back in 1987 I suffered a heart attack and subsequently had quintuple bypass surgery. That was in New York City, now living in Los Angeles. Dr. P. K. Shah by the way is my cardiologist and we started a Larry King Cardiac Foundation. That foundation helps people who can't afford it to get various heart procedures. We have -- if you want more information on the foundation it's lkcf.org.

But I wanted to read a letter. You may notice we're all wearing these little red bands. Everyone has one. I got a letter from a young man in Bethesda, Maryland. He's eleven years old.

It said, "Dear Mr. King: My name is Matthew Markel (ph) and I'm writing to you on account of a loss. My father had just died recently so I haven't been feeling so great. But when I heard about your organization I felt better because then I knew that I could save somebody else's father and make myself feel better knowing that I could save a life and spare a family from the pain this whole experience has caused me.

I really wanted to help, so I made things like "live strong" bands but instead of saying live strong it was red and said "be smart, save a heart." I have had help with my friend Mason Carmel (ph) and some other people to help me sell them in school. Thank you for taking time to read my letter."

And these are those things. That's the kind of thing that expands...

DUKE: Bravo.

JACKSON: That's great.

KING: When you have it hit home to your own, to your own. Do you take special care of your dad Jennie?

GARTH: Oh, yes.

KING: Check on him every day?

GARTH: I call pretty much every day. My mom's with him every day and he -- he's just such an amazing man. I love spending time with him. I love my two daughters to be able to spend every day with him. It's just so valued and cherished.

KING: Patty, do you do good post operative? Are you taking care of yourself?

DUKE: Yes, I did my rehab, though I tried to find every way out of it but I did go and do my rehab and now I do walking and I eat in a far more healthy fashion.

KING: Do you have to watch yourself Kate?

JACKSON: Oh, sure. Well, I was lucky. I've always sort of lived a heart healthy lifestyle, which is sort of what we were talking about a minute ago. We're concentrating on what happens after heart disease has been diagnosed and what do you do to keep it from happening because it is a lifestyle choice pretty much?

You choose what you eat. You choose whether or not you exercise and you choose whether or not you smoke, which is probably the one single most devastating thing you can do to your health anyway.

But, if you choose to eat a heart healthy diet and it's easy to find out what that is, you can go to the American Heart Association's Web site and many other places, if you choose to exercise, half an hour a day and if you choose not to smoke you will not choose to have heart disease.

If you don't, if you make the other choices and you eat lots of fat and you get your cholesterol all up and you live a sedentary lifestyle and you smoke, then you choose heart disease. So, if we can, like on this show, if we can -- if we can maybe help a few people who are watching not choose heart disease we will have done an awful lot.

KING: And you can choose it. What, Dr. Shah and the same one for Dr. Agatston, what about this whole disease process, you work with it every day, puzzles you the most?

SHAH: Well...

KING: What about heart disease knocks your mind out?

SHAH: I completely agree with Kate. It's largely a lifestyle issue but not entirely. There are genetic predispositions for some individuals that they look at a cigarette, let alone smoke, and they drop dead of a heart attack. And there are others, like Winston Churchill, who smoke, who are fat, who have high cholesterol, they live to be 90. What's different...

KING: What is it?

SHAH: ...is the genetic make up. But genes basically load the gun. Lifestyle pulls the trigger.

KING: Can you ever change the gene?

SHAH: You can abort the consequences of a genetic predisposition by adopting a healthy lifestyle. You can suppress it.

KING: But what, Dr. Agatston, bugs you about the disease itself? What is it about the disease that confounds you?

AGATSTON: Well, when I hear -- well, really the way it's often forgotten and we don't appreciate how treatable it is. And when you read a story like that 11-year-old who lost his dad and I feel that that's completely preventable.

And we have to realize that for somebody who's heading for a heart attack in their 50s, 60s, 70s, there's arteriosclerosis building up in your teenage, young adult years. Twenty-five percent of Vietnam casualties already had arteriosclerosis in their artery walls, so it's a long process and it gives us a long time to intervene.

And we can, we have to know our risk factors and if we -- if we have risk factors then we have to really be careful about diet and lifestyle and about early diagnosis, do regular blood tests. There are imaging studies today where you can see the buildup of plaque in the arteries years before it causes a heart attack or stroke, so early detection and early treatment is key.

KING: I take eleven different drugs a day. How many do you take?

DUKE: I don't take any heart medicine.

KING: No? DUKE: None.

KING: Your father how many does he take?

GARTH: I couldn't count the amount of medicine that he takes on a daily basis.

KING: A lot? How much do you take Kate?

JACKSON: Two baby aspirin.

KING: That's all?

JACKSON: Yes. I mean I take my vitamins and I get a lot of medicine through my (INAUDIBLE).

KING: Are there wonder drugs in this field?

SHAH: Well, there are wonder drugs that we have currently available.

KING: Yes.

SHAH: And for reducing the risk of a heart attack or a stroke among the medications aspirin is effective. Cholesterol-lowering medications like the statins are effective in the vast majority of cases.

But coming down the pike are new classes of medications that will allow us to actually reverse plaque that's already there and these medications are based on boosting the function or the levels of the good cholesterol in the body, which is the HDL cholesterol.

One of these drugs we developed in our laboratory at Cedars-Sinai is an injectable HDL that once the clinical trials are completed and if they confirm what we saw in our animal tests in shrinking plaque, we will have in the next three to four years drugs like that and many others that work similarly to reverse plaque buildup. So, I think the future actually looks very good (INAUDIBLE).

(CROSSTALK)

KING: We'll take -- let me get a break, Kate. We'll pick up on that. That's extraordinary. Don't go away. We'll be right back.

(BEGIN VIDEO CLIP)

BILL CLINTON, FORMER PRESIDENT OF THE UNITED STATES (by telephone): You know some of this is genetic and I may have done some damage in those years when I was too careless about what I ate. So, for whatever reason, I've got a problem and I've got a chance to deal with it and I feel that I've really got -- let me just say this. Republicans aren't the only people who want four more years here.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

KING: Dr. Agatston, what do you make of what Dr. Shah just said about the possibility of reversing plaque?

AGATSTON: Absolutely and I know Dr. Shah's work and in one of the proteins he worked with, called the Milano protein that they injected in humans and could see on ultrasound that it actually shrunk plaque in a matter of weeks and one of the exciting things is they had to document this at catherization with an invasive test, the intravascular ultrasound.

But we're getting to a point with non-invasive imaging with the new 64-slice scanner, CT scanner and there are some new generations coming down the pike where we'll be able to really do a non-invasive intravascular ultrasound.

We'll be able to see the plaque building up and then when we use these revolutionary medications that Dr. Shah is talking about, we'll actually be able to document in the individual that they're working.

Everybody has their own level of cholesterol where they're laying down plaque and we'll be able to see who's laying down plaque and how the medications are working.

KING: Dr. Shah, the number one selling drug in the world is Lipitor, got to be a reason for that.

SHAH: Yes, it's a very effective way to lower the bad cholesterol levels and studies have shown that that reduces risk of a heart attack, a stroke and death.

KING: Now they're (INAUDIBLE) where they prevent stroke.

SHAH: That is correct because basically 90 percent of strokes are due to blood clots and plaques in the arteries of the brain. Ten percent are due to hemorrhage or bleeding.

And those strokes that are due to blood clots and plaque can be dramatically reduced by controlling cholesterol levels and using aspirin and other blood thinning medications. So, stroke like heart attack, many cases are actually preventable.

KING: Do you go in for checkups Patty?

DUKE: You bet. You bet. They are so important. And, I would like to see Dr. Burnette (ph) again. He's very special to me.

KING: Your dad stay on top of things?

GARTH: Yes. He's on a very strict schedule and I think through all of that I'm really learning so much, like about women and appreciating their heart, you know, because I think about it as a woman. I spend a lot of time worrying about things that I can see, my hair, my body, my breasts even and all kinds of things like that but I don't really ever stop to appreciate my heart or to think about all the work that it's doing. KING: You worry more about breast cancer than heart?

DUKE: Exactly.

GARTH: I think yes before my experience with this I did. I had never known and most women don't know that it's the number one killer of American women and that was just devastating news to me.

DUKE: And that it's fixable.

GARTH: Yes, exactly. If you make the right choices, as you were saying, and go and see your doctor.

KING: Are you aware, Kate, that while breast cancer is more -- people have more of an image of the threat, heart is a bigger threat?

JACKSON: Yes, I was aware. I knew because my mother's father had had -- had dropped dead when he was 41 years old and so that had affected my mom's life a lot and so she was -- she was conscious of her heart.

KING: But of your own fear did you fear breast cancer more than heart disease (INAUDIBLE)?

JACKSON: You know to tell you the truth, Larry, I didn't fear anything then. I was young. I didn't know...

DUKE: Invincible.

JACKSON: ...that life happens, you know. I thought it happens to somebody else.

GARTH: Yes.

JACKSON: And, you know I didn't -- I didn't think about fearing.

KING: It's that old EKG still important which only it measures the heart at that minute right?

SHAH: Yes, EKG...

KING: You can take an EKG and drop dead walking out of the office.

SHAH: The EKG is important but it is often not sufficient by itself. Nowadays, as Dr. Agatston mentioned, we have the ability to identify the buildup of plaque in the arteries to the brain and the arteries to the heart using non-invasive imaging tests like a CT of the heart or an ultrasound long before it produces any narrowing, long before it produces any symptom, long before the EKG becomes abnormal, long before even the stress test becomes abnormal we can detect the disease.

So, really people need to understand what their risks are and should be asking their physicians do I have this disease? Should I be making some changes in my lifestyle? I think proactively, people are proactive the vast majority of these premature events can be prevented.

JACKSON: And women especially should insist that they be treated as you would treat a man that you would think is becoming of the age and all that, that he's at risk for heart disease, the executive who's in his 50s and he's overweight and he doesn't exercise enough and the doctor begins to worry about his heart. A woman should say treat me as if I were a man. Now, I'm however old I am, what are my risk factors?

KING: We'll talk about cholesterol and the baby boomers. As we go to break, I'll reintroduce the panel, don't go away.

(BEGIN VIDEO CLIP)

KING: You jump though at pain right? We all do.

DICK CHENEY, VICE PRESIDENT OF THE UNITED STATES: Yes, and I've never, I'm sure the same is true for you, Larry, you become very sensitive to what's going on.

KING: Oh, do you and you think sometimes you get false feelings.

CHENEY: Occasionally you get false feelings but it's never been intense pain but it doesn't take much to trigger it and say well I better go have it checked (INAUDIBLE).

KING: And that's the smart thing.

CHENEY: Absolutely.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

KING: This is national "Go Red Day" and Barbara -- Laura Bush and others are supporting this nationally, as we focus attention on women and heart disease in this appropriate month of February. And as I said earlier, the Larry King Cardiac Foundation is also very, very involved in helping people help themselves. And for more information on that it's LKCF.org.

And let's meet our panel. Patty Duke is the Oscar and Emmy- winning actress who underwent heart bypass surgery in 2004. Jennie Garth is the actress with credits that include staring roles in TV series "What I Like about You" and "Beverly Hills 90210." Her father had a heart attack when she was nine, and he's had several open heart surgeries. She volunteers for the "Go Red for Women" campaign.

Kate Jackson, actress who underwent cardiac surgery as an adult to correct a hole in her heart. Past recipient of the American Heart Association's "Power of Love" award for her ongoing effort to increase public awareness of heart disease.

Dr. P.K. Shah is the internationally renowned cardiologist, director of the Division of Cardiology and Arthrosclerosis at the Research Center at Cedars-Sinai, professor of medicine USL School of Medicine, a member of the Medical Advisory Board of the King Cardiac Foundation.

And Dr. Arthur Agatston, cardiologist, associate professor of medicine at the University of Miami, Miller School of Medicine, and author of best-selling books, you know them as the South Beach Diet books.

Dr. Shah was saying something during the break that I never quite heard. You could have a mate break up with you, you could get bad news and get a heart attack.

SHAH: That's correct. This is particularly true for women, death of a spouse. Sometimes even extreme good news can trigger can trigger...

KING: Also the death of a spouse.

SHAH: That's right.

(LAUGHTER)

(CROSSTALK)

SHAH: Which may be good news for some -- can trigger a massive surge of adrenaline in the body which rapidly paralyzes the heart, creates a situation, looks like a heart attack, and you can really either die from it, if you're lucky you get into the hospital. The angiogram shows the arteries are normal, but the heart is paralyzed. Luckily for most such patients, the recovery tends to be nearly complete, in most cases.

UNIDENTIFIED FEMALE: Wow.

KING: Now, what changes the paralysis?

SHAH: What basically changes is the catecholamine or the adrenaline surge dies down, and the heart that was stunned is now recovering on its own. And for all practical purposes, unless you do an angiogram, you can't tell it from a massive heart attack, so it's really adrenaline induced, stress induced cardiac dysfunction, looking like a heart attack, it's particular to women, largely occurs in women, very rare in men.

KING: Does that surprise you Dr. Agatston?

AGATSTON: No. And I saw a case like that in my own practice about a year ago and I was shocked to hear this woman was in the emergency room. Her lipids were good, her heart stands were good, and came in, and looked at her EKG and said, you know, my feeling was, my god, you can't be having a heart attack, we've been treating so well. And we sent her to the cath lab, she had normal coronary arteries and her heart function came back to normal in several days. Her husband was giving a eulogy at a funeral when she developed her symptoms. So, again, a big surge of adrenaline.

KING: So you could win the Super Bowl and get a surge, right? SHAH: Right. Anything that creates either intense positive or negative emotion can trigger an adrenaline surge. Most often it's a negative, like the death of a spouse, or divorce or something like that. Less often it is a happy occasion.

KING: What problem are the baby boomers going to bring to heart disease?

SHAH: I'm sorry?

KING: The baby boomers.

SHAH: Well, the baby boomers aren't very concerned about what's happening. Physical inactivity, obesity, diabetes are going to create a future epidemic of heart disease, completely new epidemic, because our children are spending more time in front of the television or the terminal, and not out in the soccer field. They're eating junk food at schools, and there's very little emphasis in physical activity in schools or nutrition in schools. Obesity incidence in teenagers has doubled in the last 15 to 20 years, 16 to 20 percent of all teenagers are obese. And obesity creates diabetes, diabetes kills through cardiac disease. So we're really poised to face an epidemic of cardiovascular disease in the coming years because childhood obesity and obese kids have an 80 percent chance of growing up as obese adults.

KING: Can you reverse that, Dr. Agatston?

AGATSTON: Yes, in fact, we have a program in schools now run by our research institute where we're trying to make it change. It's not easy. And one thing we don't appreciate, right now, that the No. 1 vegetable eaten by kids is French fries and many have not really seen a healthy vegetable, or don't know what it is. One fourth-grader, when she first ate grapes at school as part of our program said, "Boy, can you get these at home?" She didn't realize they existed. And the kids are eating totally empty calories. No fruits and vegetables, none of the good fats, and not only are they overfed, and obese, but they are literally undernourished or malnourished. A lot of what we call attention deficit, behavior academic problems are due to this and that's why it's been predicted that we may be the first generation where the kids don't live as long as their parents.

And as far as the baby boomers, the -- you know, it's a demographic problem that's going to really overwhelm the medical care system. We just don't have enough primary care doctors, more are leaving or retiring than are medical students going into primary care. And there's a real danger we won't have enough doctors to take care of this coming epidemic of the baby boomers reaching the coronary artery age.

KING: Patty, do you drink alcohol?

DUKE: Not a jot.

KING: Do you? Would it be all right to have a drink once in awhile? It's OK? SHAH: For alcohol, there is a safe limit, and that's half of one drink for women per day, and one drink to maybe one and a half or two drinks for men a day. And again, for the vast majority of the people, that's an acceptable healthy limit, and may even be partially protective. But you have to also look at the converse of that. If you have a tendency to addiction, that can be a deadly habit. If you have a tendency for liver disease, that can be a problem. And alcohol also contributes calories and so weight gain, if you have a weight gain problem, that can be an issue as well.

KING: How about red wine?

SHAH: I think any form of alcohol, a shot of moonshine, is, in moderation, may be acceptable.

KING: We'll be right back. Don't go away.

(BEGIN VIDEO CLIP)

ELTON JOHN, MUSICIAN: I was on the tennis court when David, my partner, came down and said, "Elton, they'd rather you not play tennis," and I said, "Why is that?" And they said, "Well, you've got to go back. They found something wrong and they want to do deal with your heart." And I just went nuts. I though, oh, great. And I talked to my doctor, and I must admit -- you know, I'm sometimes quite renowned for my outbursts and I was just very frustrated. Maybe a little frightened. But I -- the upshot was, I went back, and he said, "Listen, all you've got to do is have this pacemaker put in." It took an hour and a half. I was back in France within 36 hours, recovering. And it's been fine

(END VIDEO CLIP)

(COMMERCIAL BREAK)

KING: If we keep on improving, and make these drastic improvements, we're going to live longer, right? You're going to have a much more aging population, aren't you?

SHAH: Correct.

KING: That gives you another problem.

UNIDENTIFIED FEMALE: I'll take it.

SHAH: It's expensive. Because if you have more older people living longer, it is conceivable that our social structure cannot handle it so many nonagenarians or centenarians. So I think there are potential downsides to living too long.

KING: For you maybe.

SHAH: From a societal reasons.

DUKE: You can modify it except for me.

KING: Exercise. How important?

JACKSON: Very important. Very important.

SHAH: Absolutely. Extremely important not to be a couch potato, even 20 to 30 minutes of brisk walking can have very healthful effects overall.

KING: Walking's very good, isn't it?

SHAH: Absolutely. One of the safest exercises, and it doesn't cost you anything at all. You don't need a gym, you don't need a personal trainer. Just move, 30 minutes a day.

UNIDENTIFIED FEMALE: If you -- you don't have to like it, you just have to do it.

KING: What does stem cell research mean?

SHAH: Stem cell is -- research is really a potential that has not yet been realized. But I'm confident that in the next several years, as we understand, the signals that coax a stem cell to become a heart or a kidney or a pancreas or a brain, as we understand those signals, I think there'll be a huge, huge implication for chronic diseases like Parkinson's, like diabetes, like advanced heart failure, where if you could regrow heart muscle, help somebody with a weak heart, or regrow a normal pancreas with someone with insulin requiring it for diabetes, or replace the tissue that's abnormal in Parkinson's with healthy tissue, I think you could really make a huge impact. But we're at the primary stage, we're not there yet. I think it's going to take...

JACKSON: My father had Parkinson's disease...

SHAH: Yes.

JACKSON: And I hope you...

SHAH: It's going to take time, because the signs are moving at a rapid pace, but we're not quite there yet. I'm very optimistic in the future about...

KING: About transplants. By the way, are there some things that women -- someone told me today that there are certain procedures that women don't handle as well as men regarding the heart. Is there such a thing like angiograms? Do the women handle them the same way men do?

SHAH: Yeah, generally, I don't think there's a problem with that. Women tend to have smaller arteries compared to men, in general. And also, when women get plaque buildup, sometimes the plaque buildup is more diffused than localized certain segments of the arteries, so there are differences between the way women and men react to heart disease.

KING: Were you going to say something, Dr. Agatston? AGATSTON: Yeah, and particularly with bypass surgery, they don't do as well as men. It's thought to be probably because they have smaller arteries to work with. But it's another reason why early diagnosis in women is so important, because they may not do as well with some of the invasive procedures.

KING: Transplants, how far have they come?

SHAH: Cardiac transplant? At the present time, for end stage heart disease, it's the only game in town. I mean, if somebody...

KING: How many people have them?

SHAH: Well, about 2,000 transplants are done a year, in the United States, roughly. But there are four times as many people as needs them but cannot get them because there's not enough donors. So there's a donor shortage, so a lot of people actually die while waiting for a transplant, because there's not enough donors.

KING: And when you get it, how well does it work?

SHAH: Well, let's put it this way. Once you put a new heart into somebody, you have a one-year likelihood of dying of about five percent to 10 percent. Means 90 to 95 percent chance that you'll survive. And then over the next five years, you lose about 20 percent to 30 percent of the people. So, 70 percent survival by five years after a transplant. That's, in a group of people who, without a transplant would have...

KING: All died.

SHAH: Practically all be dead by then, so it is a big advance, but it is a major commitment on the part of society, the doctors, the physicians, the patient, because these patients have to take 20, 30 different medications to prevent rejection, to prevent infection, and to prevent the complication of the anti-rejection medications. So, it's a...

KING: You mean you take medicine because of the medicine that you take.

SHAH: Exactly.

KING: We'll take a break now and analyze that. We'll be back with more, don't go away.

(COMMERCIAL BREAK)

KING: We're back. By the way, for the record, we mentioned a few medications in the course of our discussion tonight, but LARRY KING LIVE is not promoting the use of any specific drugs. In fact, no drugs should be used without first getting your doctor's approval, which, of course, with prescription drugs, you would think is the only way to get it. However, one day I'll figure it out. Stress and -- do you think stress played a part in your... DUKE: I do. I do. The symptoms started with shortness of breath and, you know, I have been known to be emotional. So, I wouldn't be surprised if I heard good or bad news and have heart attack. That would be, you know, logical for me.

GARTH: Now that you know about it.

DUKE: Now that I know about it, I'm going to work it out.

KING: Are you good with stress?

DUKE: It's funny, I am. What I'm not good with is the stress I provoke. You know, the things I worry about that have nothing to do with reality, really. That is far more stressful than the stresses of the day.

KING: When we return to our psychiatric panel, we'll have you back.

(LAUGHTER)

KING: Stress get to you, Jennie?

GARTH: Yes, it does.

KING: You look like the kind that would.

GARTH: I look stressed out?

KING: No (UNINTELLIGIBLE).

GARTH: I try to -- I handle situations well, under the gun, when there's something bad happening. I mean, so many times when my dad was in the hospital, and it was just so traumatic on me as a young girl, and a teenager and a young woman it -- I'm surprised and shocked that I or my mom or sisters have not dropped dead from a heart attack during all of that, ourselves. It's...

KING: Kate?

JACKSON: How well do I handle stress? Oh, well, I guess I handle it -- I'm aware of it and I'm aware that I need to handle it well. I need not to, you know, let it overwhelm me, so...

KING: Do you handle it well, P.K.?

SHAH: Well, in general, yes. But, when I lose a patient, I'm devastated. And that kind of stress is very difficult.

KING: Do you blame yourself?

SHAH: Not necessarily blame, it's just some sadness associated with a loss of life because in my view all our lives, we work to preserve life and then when somebody just doesn't make it, it is devastating...

KING: I had a doctor tell me once that when a patient dies, a little bit of him dies.

SHAH: Absolutely. Absolutely.

KING: Dr. Agatston, how well do you handle the stress of your profession?

AGATSTON: Well, I enjoy just about everything I do, but sometimes doing too much in a day is where the stress comes in. And I -- one point is regular exercise, which I do, really do to help stress. The adrenaline that Dr. Shah talked about before can sometimes cause a heart attack if in a sense the gun is loaded, the arteriosclerosis is there. You -- while you increase the adrenaline while you're exercising, your average level decreases and it doesn't peak as much when there is a stress, so regular exercise is a great way to combat stress.

KING: Do we know, Dr. Shah, that stress adds to heart problems? Do we know that?

SHAH: No question about it. In fact, studies in animals, like in dogs, when you make dogs very angry, their electrocardiogram can show changes that looking like a heart attack and that was done in Boston, actually, by Bernard (UNINTELLIGIBLE). So we know stress can actually induce narrowing -- acute narrowing of the coronary artery. We also know from studies done at Cedars, by my colleague, Dr. (UNINTELLIGIBLE), that mental stress can provoke reduction of blood flow to the heart, and you can document that. So, there's no question that stress can have adverse consequences, especially if you already have the disease, it can only add to that risk.

KING: We'll be back with our remaining moments on this very special day. It's the American Heart Association's "Go Red for Women" campaign, being spearheaded by the first lady and that's why we're all wearing red and so involved in focusing the attention on women and heart disease. We'll be right back.

(BEGIN VIDEO CLIP)

LAURA BUSH, FIRST LADY: I hope people will wear red on Friday. Wear a red tie if you're a man or a red dress or suit if you're a woman, to get the message out that heart disease is the No. 1 killer of American women. And the good news about that is that women can change their lifestyle, and heart disease is -- can be preventable

(END VIDEO CLIP)

KING: Since we're discussing women tonight, and we're in our remaining moments, Dr. Shah wanted to point out another thing, particularly to women.

SHAH: Yeah, some women, particularly young women, who may be completely healthy otherwise, with normal cholesterol, nonsmokers, no high blood pressure, no diabetes, no family history, can, on rare occasions suddenly get a heart attack when the inner lining of their coronary artery tears apart, separates, and causes an abrupt closure of the artery, this is called coronary dissection. This occurs five to 10 times more commonly in women than in men. With otherwise perfect normal arteries, they can just fall apart and trigger a heart attack. We don't know why. It's light lightning striking them.

KING: Do they recover?

SHAH: Many of will recover, some will die and in some, we can put a stint and open the artery, some require bypass surgery. The point that I want to make is that women, when they get severe chest pain, even if they are young, even if they are otherwise healthy, never assume that it cannot be heart, because it can be heart, and it may be due to this peculiar coronary dissection. It's rare, but it does happen.

KING: Are you saying that anyone watching this show, women, men, anyone, you get severe chest pain, you call 911.

SHAH: Absolutely.

JACKSON: You bet.

SHAH: Don't call your doctor, don't call your spouse, call 911. You want to be taken to the hospital.

KING: It's a wasted time...

SHAH: Absolutely.

KING: Dr. Agatston, do you agree?

AGATSTON: Yeah. Because the quicker you get to the hospital, the quicker an obstructed vessel can be opened and that's a time when the invasive procedures are wonderful. You can open an artery the sooner you get to the hospital, the sooner it's open, the better the chance that it stays open and that you really abort the heart attack.

KING: And the people on those emergency vehicles that come to get you know what to do, don't they?

SHAH: By and large, yes.

JACKSON: They are wonderful.

KING: They're well trained?

SHAH: The paramedics are very well trained and they are life savers. No question about it.

JACKSON: It's better to go to the hospital in one of those vehicles than to have someone drive to you the hospital or take a cab.

SHAH: The worse the thing you can do is have someone drive you.

JACKSON: Yeah, that's not a good idea:

SHAH: Because if your heart stops en route, there's nothing they can do. While if you are in the paramedic ambulance, they can revive you. And the risk of a heart stopping is the highest in the first hour to two after a heart attack. That's the most vulnerable period when the heart suddenly completely stops. So you don't want to be in a situation where there is no expert help available en route.

KING: In my case, I did not have chest pain, I had shoulder pain. It went straight down my shoulder. I never had chest pain.

SHAH: Yeah, a lot of manifestations of heart attack do not involve chest pain at all.

KING: Sometimes people get...

SHAH: Jaw, chest, throat, shoulder and sometimes back pain. They can all be manifestations -- I had a patient who once had eye pain, as a manifestation of heart attack. She went to the ophthalmologist and he said, I don't find anything wrong with your eye. She came to see us, we gave her an EKG, and she was having a heart attack. And it was eye pain which is a rare thing, but pain in other parts of the body can be a manifestation of a heart attack.

KING: The heart -- yes, Doctor, go ahead.

AGATSTON: Yeah, there was a famous cardiologist, Dr. Lyon (ph), in Boston whose brother was a dentist and he learned about the signs of heart attack and several times people came to him with jaw pain that he realized was not the teeth, but was heart and got them to the hospital.

KING: Well, we should all be encouraged with the more we learn.

DUKE: The hope I'm hearing here is spectacular and I think it is what women and men need when something happens, some sort of crisis happens that could be heart.

KING: And this "Go for Red," great idea.

GARTH: Yes, and just to educate and inspire women to take better care of their hearts and health. I think, I for one, have had an eye- opening, and I think I might be going home with Dr. Shah, if that's OK?

KING: Very helpful, right, Kate?

JACKSON: Oh, yeah.

KING: The more you do, the more we do?

JACKSON: And the more we talk about it and the more we talk about prevention, because, you know, it's preventable, 80 to 90 percent. Isn't that right, 80 to 90 percent of heart disease is preventable? You can -- you don't have to have it.

KING: Well, I thank you all very much for an illuminating hour and I want to thank everybody involved, they are Patty Duke, Jennie Garth, Kate Jackson, Dr. P.K. Shah, and in Miami Dr. Arthur Agatston the author of those best-selling South Beach Diet books. I think they're the best-selling diet books ever written.

I want to thank our friends at our own Larry King Cardiac Foundation, as well. You want to contact them at LKCF.org.

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