Clinton likely was headed for major heart attack
Doctors say former president doing fine after surgery
 |  Dr. Craig Smith uses a model to illustrate the surgery President Clinton underwent Monday. |
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 Clinton had a "relatively routine quadruple bypass operation."
 Clinton undergoes coronary artery bypass surgery.
 Clinton talks to CNN about his bypass surgery.
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NEW YORK (CNN) -- After operating on former President Clinton's heart, his doctors said his coronary arteries were so severely clogged that a major heart attack was not far off.
Doctors found extensive heart disease during Clinton's four-hour quadruple coronary artery bypass operation Monday at New York-Presbyterian Hospital. Some arteries were more than 90 percent blocked.
"There was a substantial likelihood that he would have had a substantial heart attack in the near future," said Dr. Allan Schwartz, chief of cardiology.
The Clinton Foundation issued a statement saying Clinton was "resting comfortably as he continues to recuperate. He is awake and alert, and talking with his family."
Doctors said Clinton was taken off his respirator Monday night.
The former president still was listed in critical condition, but he was expected to be moved out of the intensive care unit later Tuesday.
"He's sitting up, talking, having a normal amount of discomfort, but actually he's doing just fine," said Dr. Craig Smith, chief cardiothoracic surgeon.
Doctors said he could leave the hospital in four or five days.
"These past few days have been quite an emotional roller coaster for us," Clinton's wife, Sen. Hillary Rodham Clinton, said in a statement. "The president's optimism and faith will carry him through the difficult weeks and months ahead -- of that we have no doubt."
The 58-year-old former president went to the hospital late last week after complaining of chest pain and shortness of breath.
Doctors now say Clinton had those symptoms for months but had assumed it was because he had been exercising less and had indigestion.
After experiencing a 15- to 20-minute episode of shortness of breath and chest tightness at rest, the former president sought medical attention, Schwartz said.
An angiogram showed he had blockages in some coronary arteries, caused by fatty plaque over the years, doctors said.
The doctors also said Clinton has had high blood pressure and his previous treatment for high cholesterol may not have been effective, according to the AP.
Clinton's exercise and diet routines in recent years have been well known, but when he left office in early 2001 his cholesterol level was at 233 milligrams per deciliter. That is above the upper edge of the normal range, which is 200.
Most doctors recommend even lower levels. Clinton's LDL, or so-called "bad cholesterol" level, was 177 and had jumped 40 points during the last year of his presidency. Normal LDL is considered lower than 130.
A dangerous state
Because Clinton had been using a blood-thinning medication, Plavix, doctors waited a few days before operating to lessen the chance of excessive bleeding, they said.
Smith, who performs about 350 bypasses every year, said he made the decision to operate on Clinton with the former president's heart stopped.
"The reason for that is that when I saw the heart and could actually look at the specific nature of the branches that I was going to bypass, I decided it was going to be better, safer, easier to do it with the heart stopped," the physician said.
While Clinton's heart was stopped, he was put on a heart-lung machine for more than an hour. Two chest arteries and a vein from his leg were used for the bypasses.
Smith said the only pressures felt by those participating in the surgery came because of who their patient was.
"The pressure here is to avoid bad decision-making because of over-concern about doing too much or too little, so that you either become too bold or too timid," he said.
Schwartz said Monday that Clinton can remain active. But now he will have to work to make sure he doesn't develop new blockages.
He will need to make changes in his medication and diet and continue his exercise program, Schwartz said.
Diet and genes
There is a history of heart disease in Clinton's family, but he also admits he has not been careful about what he ate.
He has lost weight over the past few months, saying he has gotten more exercise and has been on the South Beach diet.
Clinton had planned to campaign for Sen. John Kerry, the Democratic nominee, but Smith said Clinton will need to be sensible.
"How soon he can go back to work will have a lot to do with how well he can control the environment he's going into," Smith said.
"If he's going to step into a campaign scene where he's got to be 110 percent, 48 hours running, he's not going to be able to do that for awhile."
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Associated Press contributed to this report.
