Ilene Raymond Rush, For The Inquirer Posted: Sunday, February 15, 2015, 3:52 AM

Can a modified vegan diet - heavy on tofu, whole grains, fruits, and vegetables, and low on saturated and trans fats - significantly help with heart disease?

It's a question that Robert Fischer, head of the division of infectious diseases at Einstein Medical Center, considered last October, after his second coronary event in 61/2 years.

On the surface, Fischer, 65, of Elkins Park, appears to be an unlikely candidate for heart disease. He exhibits none of the usual risk factors. He is not overweight, hypertensive, or diabetic. He does not have high cholesterol, has never smoked, and has no family history of cardiovascular problems.

And yet.

"Early heart disease in people with no obvious risk factors is more common than appreciated," says Daniel Rader, chair of the department of genetics and director of preventive cardiovascular medicine at the University of Pennsylvania, who was not involved in Fischer's care. "Even when patients don't have clear family histories, they may have inherited genetic contributions to a risk of heart disease."

Seven years earlier, at age 58, Fischer had experienced a "vague sensation of something wrong" as he jogged along Tookany Creek Parkway. He ran through the possibilities - maybe it was reflux after eating, a cramp, or costochondritis, an irritation of the cartilage that connects ribs to the sternum. His pulse was fast but regular; he was not dizzy or in severe pain.

A trip to the emergency room, however, showed that he had had a heart attack. A catheterization revealed two lesions where plaque had blocked a branch of the right coronary artery, which supplies blood to the lower part of the left ventricle, requiring two stents. He was sent home with statins, beta-blockers, and the blood thinner Plavix, and was back to his running schedule two weeks later.

That worked until a Friday morning in October 2014, when Fischer climbed from the fourth to the eighth floor after rounds and found himself severely short of breath and light-headed, as if he were about to lose consciousness. He headed to emergency, but a cardiac enzyme test and ECG showed normal results. At home he felt better, but on Monday, he ran up two or three flights and was hit by the same symptoms.

"Freaked out," Fischer went to his internist, where he was found to have unstable angina and acute coronary syndrome. A catheterization found another blockage in the proximal left anterior descending artery, the principal blood supplier of the left ventricle.

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Physician turned patient finds low fat good for his heart