Tony Soprano’s last stand: How heart disease may have led to James Gandolfini’s death

This May 20, 2013 photo shows actor James Gandolfini at the Los Angeles premiere of "Nicky Deuce" in Los Angeles. HBO and the managers for Gandolfini say the actor died Wednesday, June 19, 2013, in Italy. He was 51. (Photo by Richard Shotwell/Invision/AP, File)

James Gandolfini, the larger-than-life Emmy award-winning actor who played mob boss Tony Soprano, has met his end in Rome, due to an apparent heart attack. At age 51, his passing was entirely premature.

As Tony Soprano, Gandolfini insinuated himself into popular culture as the big, menacing, complex and implacable mobster who ruled his criminal empire with old-school, strong-arm tactics. But every tough guy knows that there’s someone – or something – tougher out there. For Tony Soprano, the hit man was likely heart disease.

The much-beloved Gandolfini was by all accounts a marvelous friend and deeply respected by his peers. He had a charismatic personality and a great sense of humor. He was also very overweight, a cigar smoker and a man known to remain at the dinner table until the last strands of pasta and crumbs of tiramisu had been taken care of. As Tony Soprano, he could menace just about anybody. But as actor Gandolfini, his lifestyle vulnerabilities made him an easy target for a highly efficient silent killer.

As famous as he was, Gandolfini’s death added only a tiny notch in the belt of the ultimate assassin: heart disease. Gandolfini was just one of the more than 600,000 people to fall victim to fatal heart disease in the U.S. each year. The difference between Gandolfini and all other victims of cardiovascular disease is that he was globally famous.

What we can learn from a meteoric life - lived large and ended too soon - is that no matter who you are, no matter how famous, rich, awarded and popular you become, heart disease can get you.

Obesity is associated with increased rates of heart attack, stroke, high blood pressure and arterial disease. Tobacco smoking is also a major cardiovascular risk factor. Consistently large eating habits can lead to a large coronary event. Gandolfini did it all: lived too heavy, enjoyed his fine cigars and packed in the food. Like a recipe for a perfect marinara, Gandolfini’s life was a perfect formula for a heart attack.

At this point in time, the rules of cardiovascular health are fairly well understood. Eating foods low in fat, exercising daily, eradicating any and all smoking from your life and reducing stress are all factors in maintaining a healthy heart and living longer.

Omega-3 fatty acids from fish appear to be significantly protective to the heart and eating lots of soluble and insoluble fiber helps to regulate metabolism, eliminate waste, control blood sugar and reduce cardiovascular disease risk. Herbs like hawthorn and green tea and supplements like OPC’s and Coenzyme Q 10 can help you to keep your heart healthier, longer. But lifestyle still matters most.

We become attached to celebrities in our imagination. We watch them perform, relate in various ways to the characters they portray, celebrate their on-stage victories and feel for them in their scripted defeats. According to those who knew him, Gandolfini was nothing like Tony Soprano. He was instead a softer, more thoughtful man and a highly driven actor who put his all into his performances and enjoyed a wide range of friends. And that makes his death even sadder.

Nobody here gets out alive. How long we get to stick around depends to a great extent upon how we live. Violate the fundamental code of healthy living and you’ll be taken out. Don’t let television characters, however tough they are portrayed, mislead you into thinking that anybody can sidestep the basics. We are all responsible to live out our days with care for our bodies. Maintaining a healthy weight, eating clean food and avoiding major health risks like smoking are all smart strategies.

James Gandolfini will be missed. The accolades will pour in. His family and friends will weep. The funeral will get international coverage. Talk shows will discuss him for weeks. Re-runs of “The Sopranos” will get a new life. But for the big mob boss whose giant personality dominated television for years, it’s closing time. Bye, Tony. We’ll miss you.