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2 Atrial fibrillation, the abnormal heart rhythm that Dave Simon has, is increasingly frequent in both the United States and Europe. About 1 to 2 percent of the population suffers from the condition, and this figure is likely to increase in the coming decades as we live longer. The lifetime risk of developing atrial fibrillation and the related condition atrial flutter is about 25 percent in those who reach the age of forty. See Donald M. Lloyd-Jones et al., “Lifetime risk for development of atrial fibrillation: The Framingham Heart Study,” Circulation 110 (2004), pp. 1042–1046; Gerald V. Naccarelli et al., “Increasing prevalence of atrial fibrillation and flutter in the United States,” American Journal of Cardiology 104 (2009), pp. 1534–1539; Jan Heeringa et al., “Prevalence, incidence and lifetime risk of atrial fibrillation: The Rotterdam study,” European Heart Journal (Eur Heart J ) 27 (2006), pp. 949–953.

2 It is estimated that about one in every five strokes is due to atrial fibrillation. See Paulus Kirchhof et al., “Outcome parameters for trials in atrial fibrillation, executive summary: Recommendation from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA),” Eur Heart J 28 (2007), pp. 2803–2817; Alan S. Go et al., “Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study,” Journal of the American Medical Association (JAMA) 285 (2001), pp. 2370–2375; Stefan Knecht et al., “Atrial fibrillation in stroke-free patients is associated with memory impairment and hippocampal atrophy,” Eur Heart J 29 (2008), pp. 2125–2132. Treatment includes anticoagulation that helps prevent the development of clots in the heart; see Elaine M. Hylek et al., “Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation,” New England Journal of Medicine (NEJM) 349 (2003), pp. 1019–1026; Robert G. Hart, Lesly A. Pearce, Maria I. Aguilar, “Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation,” Annals of Internal Medicine (Ann Intern Med) 146 (2007), pp. 857–867. New anticoagulants were approved in 2010 for treatment of atrial fibrillation that are easier to monitor and pose a somewhat lower risk of bleeding: Stuart J. Connolly et al., “Dabigatran versus warfarin in patients with atrial fibrillation,” NEJM 361 (2009), pp. 1139–1151; Brian F. Gage, “Can we rely on RE-LY?” NEJM 361 (2009), pp. 1200–1202.

3 The relationship between high blood cholesterol and cardiovascular disease was first recognized in large epidemiological studies like the famous one conducted in Framingham, Massachusetts. In that study, local residents were followed for decades by researchers who assessed not only blood lipids like cholesterol, but also hypertension, diabetes, and personal habits, like smoking: Daniel Levy, Susan Brink, A Change of Heart: How the People of Framingham, Massachusetts, Helped Unravel the Mysteries of Cardiovascular Disease (New York: Alfred A. Knopf, 2005); Daniel Levy, “50 years of discovery: Medical milestones from the National Heart, Lung, and Blood Institute’s Framingham Heart Study,” Hackensack, NJ: Center for Bio-Medical Communication, 1999.

3 An excellent clinical overview on preventing a future heart attack with statin medications: Michael J. Domanski, “Primary prevention of coronary artery disease,” NEJM 357 (2007), pp. 1543–1545.

4 Michelle Byrd had an unusual side effect of abdominal pain with the second medication for her blood pressure, described in Troy D. Schmidt and Kevin M. McGrath, “Angiotension-converting enzyme inhibitor angioedema of the intestine: A case report and review of the literature,” American Journal of the Medical Sciences 324 (2002), pp. 106–108; Thomas J. Byrne et al., “Isolated visceral angioedema: An underdiagnosed complication of ACE inhibitors,