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Anyone who's seen Bill Clinton in the past few months — speaking at the White House ceremony when his portrait was unveiled in May, delivering a ringing speech in support of John Kerry at the Democratic National Convention in July, signing copies of his book all over the world this summer — couldn't help noticing that he was full of energy and looking mighty svelte. The ex-President was thin — not just for the famously chubby Clinton — but thin by anyone's standard. How did he do it? He had been on the South Beach diet, he told friends, and was getting plenty of exercise. "I'm eating better and working out hard," he said.

Eating right and exercising are the ideal prescriptions for weight loss, and experts agree they're also the best way to prevent heart disease. So it came as a shock last week to learn that Clinton, 58, had been admitted to New York — Presbyterian Hospital after complaining of mild chest pain and shortness of breath, and was put on the fast track for quadruple-bypass surgery. Four of the arteries supplying blood to his heart muscles were so clogged that doctors would have to raid vessels from elsewhere in his body to funnel blood around them.

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But it wasn't a shock to anyone who knew Clinton's history and something about heart disease. "How could it happen?" asks Dr. P.K. Shah, director of cardiology at Cedars-Sinai Medical Center in Los Angeles. "Very simple: you cannot reverse a lifetime of heart-unhealthy habits by getting religion for a year."

If anyone had had bad habits, it was Bill Clinton. Long before he got to the White House, he was known for his love of fatty food; shortly after he got there comedians began making fat-President jokes. Jay Leno suggested appointing a Thighmaster General. On Saturday Night Live, the President (played by Phil Hartman) illustrated impromptu lessons on economics by taking bites out of other people's food.

All those saturated fats and that cholesterol from burgers and tacos and barbecued ribs went not just to Clinton's waist but into his blood as well. And those fats built up into fatty deposits known as plaques that slowly but surely massed within the walls of his heart arteries.

The President did lose weight every so often only to gain it back again time after time. That's known as yo-yo dieting, and cardiologists believe it's even worse for the arteries than just staying fat, especially for someone like Clinton, with a stressful job and a family history of heart problems. When he became President, his cholesterol was a borderline 203. By the time he left office, it was a dangerous 233, and his blood pressure was 136 over 84.

But Clinton says he "aced" all his stress tests and had no major symptoms until last week. That's not unusual. According to Shah, in about 40% of cases, the first indication of heart disease is a heart attack or sudden death. "I feel really blessed," Clinton told TV-host Larry King last Friday, "because a lot of people who have a heart attack don't get any warning."

Clinton is also lucky that he's relatively young — although not that young. The average age for a first heart attack is in the mid-50s; King had a bypass at 54, and talk-show host David Letterman had one at 52. Clinton is likely to get through this routine-though-serious surgery with no problem. (Only 1% or 2% of the half a million or so people who have coronary bypasses each year die under the knife.) His biggest problem at the hospital might be overcrowding: the Emir of Kuwait, also in for treatment, has taken several rooms on the same floor as Clinton.

The fact that dieting didn't cure him of heart disease hardly means it was a waste of time. Whatever damage Clinton was doing to his arteries when he was abusing his body was probably put on hold while he cleaned up his act. And if he keeps eating right and exercising after the surgery, he has a good chance of staving off more serious heart problems. For now, he just wants to get it over with. "Republicans," quipped an upbeat Clinton last week, "aren't the only people who want four more years."

• Michael D. Lemonick