Stress of the trial. Ya..or maybe the 2 packs a day...I don’t think it’s by pass, I think stints or however it’s spelled, I don’t think it’s a long delay in trial either..nowadays bypass is like pulling teeth by the way, I know multiple people who have lived quarter century plus after ..don’t get me wrong,it’s not a good thing, but if u have it done and live the right way after, you can live a long time