By Patricia Corrigan, St. Louis Post-Dispatch, February 12, 2007

Who: Anne Fagan Niven
Age:44
Home: St. Louis
Occupation: Research associate professor in neurology at Washington University School of Medicine
What she did: After suffering a heart attack at 39, Niven changed her behaviors — and parts of her
personality - to better cope with stress.
Quotable: "I''ve always been an overachiever, living life with a sense of urgency, thinking everything had to be done today and done perfectly. Now I know when to stop."

What: Woman''s Heart Day Health Fair, featuring free screenings for heart health with on-the-spot results and advice.
Why: Heart disease is women''s No. 1 health threat, killing more women than the next six causes of death combined.
Where: St. Louis Galleria
When: 8 a.m. to 5 p.m. Friday
How much: Free
More info: 314-867-3627 or www.sistertosister.org. Registration is encouraged.

Lying in the intensive care unit of a hospital in Naples, Fla., after surgery, Anne Fagan Niven did not immediately appreciate the gravity of her circumstances. Enlightenment came the morning after her heart attack, when the helicopter pilot who had brought Niven to the hospital walked into her room.

"She told me that 99 percent of the people she transports don''t make it," Niven says. "She wanted to shake my hand."

Five years ago on Jan. 5, Niven, newly divorced, was on Marco Island, Fla., helping arrange her father''s funeral.

"Two weeks after he was declared cancer-free, my dad dropped dead of a heart attack," Niven says. "I felt like I was robbed."

Niven''s son, Gregory, then 5, was with her, as were her brother and sister-in-law, her stepmother and two stepsisters.

"I started feeling funny," Niven recalls. "My left arm was numb — a classic sign of a heart attack in men — but I had just done a massive vacuuming job, so I blamed it on that. Then I started feeling cold and clammy. There was no pain in my chest, but it was a little hard to breathe, so I lay down on the couch. My sister-in-law mentioned it was probably due to stress."

Months later, Niven''s doctors came to the same conclusion, and today she is conscientious about managing stress.

"Hindsight is 20-20," Niven says, laughing. She leaned back in the chair in her office in the Washington University School of Medicine complex. "I used to hold in my emotions. I never said ''no'' to anything — I was always on the go. And I was a huge worrier, always projecting concerns into the future. In retrospect, I see that my stress-management skills were not what they could have been. In that regard, my life has changed fundamentally."

That day

On the day that changed everything, Niven continued to feel "funny," so her brother and sister-in-law took her to a drop-in medical clinic. (There is no hospital on Marco Island.) There, Niven''s electrocardiogram showed some abnormalities.

Workers at the clinic gave Niven nitroglycerin (medication that decreases the heart''s need for oxygen by relaxing the muscles around the blood vessels) and quickly transmitted her test results to a hospital in Naples for a cardiologist to review.

"They said we would hear back in about six minutes, but that six minutes felt like it took forever," Niven says.

As she lay on the gurney, she was asked about her health history.

"I told them I work out all the time, that I am not a smoker, that I am not a diabetic. My father did die of a heart attack, but I am adopted, so that part of my history is unknown."

Suddenly, Niven went into cardiac arrest.

"The medical team shocked me back, stabilized me, intubated me and sent me to the mainland in a helicopter. At the hospital, I went into surgery, and they did a stent placement." Niven had a thrombosis, or clot, in the left anterior descending vessel — an artery known as "the widow maker" because few people survive blockage there.

Recovery

Niven was in the intensive care unit for three days and missed her father''s funeral. When she left the hospital, her former husband''s father and stepmother took Niven to their home in Savannah, Ga., for three weeks.

"I was exhausted, and I was a mess," she said.

Then, they drove Niven home to St. Louis. Her former mother-in-law stayed with Niven for three months, driving Niven to work until she was permitted to drive herself.

Niven joined a cardiac rehabilitation program. She thought she would bounce back, but she didn''t.

"Little by little, I got my strength back," she says. "I wanted to know why this had happened. I am all about prevention, but I am also a scientist, and I wanted to know why."

Six months after the heart attack, tests showed no evidence of damage to her heart, and other tests ruled out other factors. "Stress, it turned out, was a diagnosis of exclusion."

A series of particularly stressful events had led up to the heart attack. Niven listed them: "My dad had been diagnosed with cancer two years earlier, and my husband and I had separated at the beginning of 2001. Then came Sept. 11, and right after that, I had to go on five plane trips. Then I was in a car accident, I got divorced — and my father died suddenly."

Making changes

Yet Niven''s perfectionism and other aspects of her personality were also to blame.

"Before the heart attack, I always felt I needed to control my environment, control all outcomes, control what people did, control how they felt," she says. "After all, I am the eldest child in my family and the only daughter. I am in a man''s world professionally, and I am a single parent. I''ve always been fiercely independent, worn that like a badge of courage. Not anymore - now I take a more spiritual approach to things."

When the fifth anniversary of the heart attack rolled around last month, Niven took the opportunity to assess how far she''s come. "Actuarially - if that is a word - five years is a big deal," she says. "I am so grateful that I listened to my body. I knew something was wrong, and I paid attention. Otherwise, I would have died."

Niven reflected on some of the changes she has made.

"We all have stress, every day, but now I manage mine so much better. I realize now that control is an illusion, and it''s a huge relief to let all that go. I also pay someone to mow the lawn and do the weeding. I always felt that I had to do everything myself, and I''ve let go of that."

She added that sometimes her house was a mess.

"For me, that''s a good thing, because it represents a huge paradigm shift."

Though most of the changes Niven has made in the past five years have been mental and emotional, some changes have been physical. She takes a beta blocker (a drug that protects the heart after a heart attack) and an aspirin every day. She works out three times a week.

"That is non-negotiable, and that helps a lot," she said.

She confessed to developing "a huge sweet tooth" but watches her diet.

One of the biggest challenges Niven still faces is quieting her busy mind.

"I know that all the internal chatter is not productive and not positive," she says, adding that she may investigate meditation. Also, Niven thinks that in the past, she has been "risk-aversive." That concerns her.

"Life is too short not to take risks, and I intend to change that part of my personality. Some of it just comes down to finding the time. Like many single parents, I do struggle with time management."

At work, Niven spends her time studying Alzheimer''s disease.

At home, she spends time with Gregory, now 10, a fourth-grader at St. Joan of Arc Elementary School. And she spends time pondering what additional changes to make that will help her manage the stresses of everyday life.

What will not change is Niven''s respect for the effect that stress can have on the body.

"I knew stress was a bad thing," she said. "Now I realize that stress can kill."