Heart Disease in the Executive Suite : Health: A coronary is always traumatic. But high-level managers often recover quickly and learn from the experience.

After several stops on a business trip to California in 1985, ConAgra Inc.’s Chairman Charles Harper was spending the weekend sightseeing in San Francisco when he suffered a heart attack.

Although it was a mild attack, it forced Harper to confront the way that he was living his life, and the experience not only improved his health but also paid an unexpected creative dividend.

A sudden illness in the executive suite can be traumatic for both a company and the victim, who faces sudden questions about whether to make profound changes in his or her personal and professional life. Many executives find that there is not only life after a heart attack, but productive work. And as more research is done into how and why heart attacks strike, some long-held myths about the vulnerability of certain business people are being exploded.

Harper, now 62, has had to make several personal changes. He cut out the 15 cups of coffee a day that he was drinking, and, in his own words, has become one of those “obnoxious” ex-smokers who lectures every smoker they meet. But the heart attack sparked a burst of creativity at work.

“When I came home from the hospital, my wife began to feed me all kinds of healthy things that tasted great. I remember she made a great chili. It was well seasoned and it had no salt,” Harper said recently. Knowing that “it is possible to have healthy food and still have it taste good,” Harper (known as Mike) put ConAgra’s food scientists to work developing recipes that could be mass produced for the grocer’s freezer case.

The result was Healthy Choice, which the Omaha, Neb.-based grain marketing and frozen foods company began selling last spring. Harper is now starring in test commercials for the low-salt, low-fat frozen dinners that are one of 1989’s new product successes.

Harper’s quick recovery isn’t unusual for executives who have heart attacks, according to medical experts.

J. W. Marriott Jr., chairman of Marriott Corp., had a heart attack Oct. 2 and returned to work on a limited basis in mid-November.

Those who specialize in cardiac rehabilitation say the speed of recovery among business executives seems to correlate with their level of authority. “The higher-level executive, better educated, more resourceful person moves more quickly out of disease, more quickly back on the job. The business person takes control and by choice joins a cardiac rehabilitation program,” said Dr. Harvey L. Alpern, clinical chief of the cardiac rehabilitation service at Cedars-Sinai Medical Center, Los Angeles.

Dr. Edward Bernacki, vice president for health and environmental safety at Tenneco Inc. in Houston, said he thinks that those at the top more readily take directions because they believe that they “have the most to lose.”

Taking directions wasn’t a problem for MCI Communications Chairman William C. McGowan, but once he was sure that he was going to make it, he became eager to get back to work, he said. Returning to work wasn’t so easy. He suffered a heart attack in 1986, was felled by a serious setback about six weeks later and had to have a heart transplant the following April to save his life. Recovery was “miraculous after that,” said McGowan.

In the early stages, McGowan said, he was consumed by the trauma of it all, but near the end of the rehabilitation period, “I started to get itchy and wanted to get back.” Executives from the company “would satisfy me by coming by to tell me what was going on at the company,” he said.

Since returning to work, McGowan has taken what is for him a slower pace. “Before, my idea of a vacation was to go somewhere and work. Now my idea of a vacation is a vacation. I don’t work on Sundays anymore. Now work is just hectic instead of crazy. I wasn’t very good at delegating. Now I don’t require myself to be involved in all of the minutiae of the business. That’s a good thing because we are spread out now and have become so decentralized,” he said.

Delegating and decentralization become more difficult for owners of small businesses. William C. Dennis, owner and president of Dennis Printers in Laguna Hills, found himself doing the work of subordinates when they took vacations. Dennis, 62, had his first heart attack in September, 1979, and a second one the following September. “Every September I get a little nervous,” he chuckled.

Dennis said he thinks that stress played a role in his first attack. “At the time, I thought I was in great health. The heart attack came along when a number of things were pending in the business. It all ultimately ended up fine, but it was taking a long time,” he said.

Dennis said his son has since joined the business and is taking over day-to-day management. Previously, he said, a “lot of loyal people stepped in and relieved me of a lot of little details.”

The most surprising reaction from co-workers, said Paul Elliot, was “certain people’s attitude that I shouldn’t say much about what had happened to me because other people would think I couldn’t do as much.” The 49-year-old vice president at Cowen & Co., a Manhattan brokerage, said he never believed that he would accomplish less after his heart attack, but the experience did teach him that there was a better way to get things done.

“I try not to go crazy over things. I prioritize. I set goals and targets as opposed to rifle shooting,” he said. After his heart attack while playing tennis, Elliot said he hired a driver for the commute to Wall Street from his home in suburban Rye, N.Y. “I have an extra two hours to do what I need to do (including making phone calls). Before, when I got to the office I had 10 calls to respond to. It was a very anxious time,” he said.

The most profound effect of the attack, he said, has been a change in his outlook on life. A heart attack, he said, drives home the reality that “there is an end to life.” He added: “Physically, I feel better now than I did before the heart attack. I’m getting exercise and I have good eating habits. Psychologically, I feel much better. It sensitizes you to what life is all about. Work is good. But it has to be put in its place. I’m enjoying life. I’m enjoying my children,” he said.

At 57, Warren Epstein is a veteran of coronary recovery. A vice president for sales at a New York fabric company, he has had three heart attacks--the last in 1983--and he’s still working. “I work just as hard, but I work smarter,” he said. He travels only during peak periods for the business, he said. Also, he said, “I have learned to walk away from stressful situations. I have reduced the anxiety in my business. It used to be that when something major didn’t get shipped on time, I would go bonkers--really make a fuss. That doesn’t change things. Now I say, let’s take a look at why it happened and let us see what we can do so that it doesn’t happen again.”

Despite the stereotype of the hard-charging, stressed-out executive who is a heart attack waiting to happen, as a group, business people in high positions have the lowest incidence of heart attacks, according to medical experts.

“I think there is a self-selection process,” said Tenneco’s Bernacki. “If you’re ill, you won’t make it to the very top. The incidence of all illness is lower. A lot of studies have shown that this group has a lower mortality,” he said. A 1963 study for Du Pont Co. in Wilmington, Del., of 86,000 workers--including more than 1,300 heart attack victims--showed top-level executives as having the lowest incidence of heart attacks and blue-collar workers the highest. Some doctors say their experience shows that the study still has validity, particularly because today’s executives seem to be better educated and more willing to practice disease prevention.

Family history and controllable factors such as high blood pressure, poor diet and lack of exercise play significant roles in heart disease, Bernacki said.

Much attention regarding heart disease among executives has focused on the role played by stress and personality type. In the 1970s the person with the so-called Type A personality (aggressive, competitive, driven) was thought to be prone to heart attacks. But several studies in the 1980s have contradicted the theory. Type A personalities don’t seem to have a higher incidence of heart attacks, and in fact, people with such a personality appear least likely to die if they do have a heart attack.

To the extent that stress is related to heart attacks, it seems that only certain types of stress are the culprits, said Cedars-Sinai’s Alpern. “There is beneficial stress--the type that allows us all to succeed. Then there is distress where there is a perception of being trapped, of not having viable alternatives,” he said, explaining that the higher incidence of heart attack occurs among people in stressful situations who feel that they have neither a way out nor control over decisions affecting their lives.

Women don’t increase their risk of heart attack when they move into management, Alpern said, but they appear to be vulnerable when they feel that they are not getting positive support for their work.

Such stress may be a factor in the higher incidence of heart attack among mid- and low-level managers, said Dr. Bruce Karrh, corporate medical director for Du Pont.

“What we find is that our lower-level managers are more susceptible. We think there are two factors. These are people who are on the front line and have more stressful interface between the top and the bottom. Also, a lot of these people are former hourly workers who have a history of poor dietary habits,” Karrh said.