The Baby Boomers

At 5 a.m. on Thanksgiving 1983, the ringing phone startled Kathleen Casey awake at her suburban Home in Voorhees, New Jersey. She grabbed the receiver on her bedside table and heard her brother-in-law, Jack Reilly, in Virginia on the line. "Your sister had a heart attack," he said. "An ambulance took her to the hospital." Kathy couldn't believe it. Ann Marie was just 36, a year and a half younger than Kathy. Yeah, her sister was a former smoker, and heart disease ran in their family. But surely she was too young for heart problems, Kathy thought. Ann Marie, Jack and their three children had been planning to make the trip to Kathy's house for the family dinner. Instead, Kathy and her two daughters, Beth, 15, and Jennifer, 13, drove three hours to Burke, Virginia, to be by Ann Marie's side. All the while, Kathy couldn't shake the nagging feeling that something was wrong, that the family curse had struck again. Few members of her immediate family had made it out of their 60s. And now Ann Marie's attack made one thing frighteningly clear: The disease was continuing its assault on generations of Caseys at an increasingly younger age. It was hard to tear her thoughts from her sister, yet Kathy couldn't help wondering whether she herself might be the next victim.

Kathleen Casey's destiny had already been set in motion. She was born in Philadelphia one second after midnight on January 1, 1946, making her the first documented Baby Boomer. That demographic phenomenon boosted the country's population by 76 million by the time it ended in 1964, and became a consumer juggernaut for cultural and economic change in America.

Kathy was mentioned in a book about Boomers, written by Landon Y. Jones, a former editor of People, and has been featured on TV and in magazines as an unofficial poster child of her generation, known for its can-do attitude and tendency toward excess. Now, as millions of Boomers enter their 50s and 60s, an increased risk of heart disease is another trait many of them have in common.

Kathy didn't know what heart disease was while growing up, even though it surrounded her. As a girl, she noticed something different about her maternal grandfather, James Carr, a bottling company owner who had lost it all after the Great Depression. Once active and lighthearted, he seemed to age before her eyes. His face would turn bright red if he got even a little upset. At some point, he had a mild heart attack, then eventually suffered a major one and died.

Some years later, Kathy's paternal grandparents also succumbed to heart-related problems. "In those days, people died from heart attacks all the time," Kathy says. "It was very matter-of-fact, something you just accepted."

Shocking Loss

As a teenager, Kathy saw her maternal grandmother, Kathryn, more as a mentor than a relative. Progressive for her time, "Nana" was a college graduate and always told Kathy and her sisters, Patricia and Ann Marie, they could accomplish anything. When Kathy was 22, she and her family were eating pork chops at Nana's house, and after the meal, her 61-year-old grandmother complained of indigestion. When the pain persisted, Kathy's uncle Jim (who would survive a heart attack nine years later) drove Nana to the hospital. She'd suffered a mild heart attack and was put on oxygen. Several days later, a major attack took her life. "I was devastated," Kathy says. "She was my best friend. If you went to the prom, she was the first one on the phone in the morning wanting to know what you did."

In the midst of all the heartache, Kathy's mother, Patricia, had been unknowingly arming her girls against the ravages of heart disease. She'd take Kathy and her girlfriends skating at the neighborhood pond. Kathy and her sisters walked to and from Catholic school every day. After school, their mother would prepare snacks of fruit or peanut butter and celery sticks. Then the girls would flick on the tube, grab a partner or the nearest doorknob as a stand-in, and dance to the Beach Boys and Frankie Valli on American Bandstand.

Through young adulthood, becoming an x-ray technician and a wife and mom, Kathy continued the good health habits. She kept to a reasonable weight by eating low-fat meals and walking and playing tennis often. Still, her cholesterol climbed. Meanwhile, her father, Matthew Casey, a former tool and die shop worker, had been struggling with his health for years. In the late 1970s, with numerous clogged arteries, he had open-heart surgery at Thomas Jefferson University Hospital in Philadelphia. The quadruple bypass was a success, helping him live another 20 years, before he developed pulmonary edema and died seven years ago, at age 79.

Heart disease had also done its silent, deadly work on Kathy's blond, blue-eyed mother. In 1980, Kathy had just gotten Home from a Girl Scouts meeting with daughter Beth when her sister Ann Marie, who lived in the next town over, called. "Get to the hospital. Jack took Mom there. We think she's had a mild heart attack."

Kathy thought for sure her 55-year-old mother would pull through. But two days later, a nurse called and said she needed Kathy and her sister to come right away. As they walked toward the entrance, they could see the doctor waiting for them through the glass doors and were overcome with dread. Their mother, who had likely suffered a subsequent attack that morning, had passed away.

"I was shocked. She was so young," Kathy says. "I thought, Oh, my gosh, my kids are never going to know her."

Now, three years later, Kathy's little sister was the eighth victim. The doctors had determined that Ann Marie's attack was the result of a clot in her hardened arteries that had stopped blood flow and damaged the back chamber of her heart -- the same scenario that led to the deaths of her grandmother and mother. Ann Marie was pumped with blood thinners for a week before doctors let her go Home with instructions to improve her diet and exercise habits. "That just did it for me," Kathy says of her sister's close call. "I said, I need to find out what I can do before this happens to me."

lifestyle Changes

Kathy continued to exercise regularly, often with her good friend Mary Ellen Rippert. Still, her cholesterol lingered on the high side. After her first marriage ended in divorce, she met and married Patrick Kirschling, a food marketing professor. By her late 40s, her total cholesterol had skyrocketed to 350 mg/dL (under 200 is a safe level).

Her good cholesterol (HDL) was a healthy 55; some experts say a high HDL is more important for women than a low bad (LDL) level. But in Kathy's case, her LDL, at 275 (under 100 is optimal), was significantly raising her risk. She tried vitamins and herbal remedies that promised to lower cholesterol, but nothing worked.

By the time Kathy turned 52, her doctor had convinced her nothing she did on her own would fix the problem. He referred her to the vascular Medicine clinic at the University of Pennsylvania health System in Philadelphia.

Despite her dangerous numbers, Kathy was still reluctant to consider medication, even as she sat in one of the clinic exam rooms for her first appointment. Emile Mohler III, MD, director of vascular Medicine, knocked on the door and entered. He reassured her that statins were safe and suggested she start with a mild one. But first he scheduled a CT scan to look for calcium in her arteries (calcium sticks to cholesterol). Kathy's arteries showed so much calcium that she fell in the 90th percentile for people her age. "She was at such a high risk, I needed to treat her like she'd already had a heart attack," Dr. Mohler says.

There was little question that Kathy and her family suffered from a family legacy of high LDL levels that started at birth. A mutated gene was causing Kathy's liver to overproduce cholesterol. Even more concerning, Kathy may have had a type of plaque prone to rupture, leading to the formation of clots, which can lodge in an artery and cause an attack without warning.

It took several years of trying different statins and doses, but by 2004, a blood test indicated that Kathy's total cholesterol had dropped to a respectable 190, with her LDL at a manageable 119. Dr. Mohler says as long as Kathy continues to eat right and exercise, she'll live 15 years longer than she would have without the drugs. She'll be around to sail the Chesapeake Bay on her trawler, First Boomer, with husband Patrick, travel to her vacation Home in Florida, and take part in every crucial moment of her grandchildren's lives -- maybe even her great-grandchildren's.

For now, Kathy is focused on passing on her good habits to her children and grandchildren. But she also worries about others of her own aging generation. Boomers tend to think they are going to "live forever," or that they can simply take a pill and erase the price of all those years of good living. Take a pill, be happy. That's classic Boomer, she says.

"I have to be on drugs. I don't have a choice. But I wonder how many people would need to be on medication if they just changed their lifestyle," Kathy says. "If you're healthy and feel good inside, that comes across outside. You'll never replace that with a pill."