Grief and heart attacks linked: Study

By Dr. Ananya Mandal, MDJan 10 2012

Researchers have found that grief might actually break ones heart. A new study shows that people grieving the death of a close loved one could have a heart attack risk that is 20 times higher than normal.

When researchers interviewed nearly 2,000 people in the early 1990s who were hospitalized after a heart attack, 270 reported that they had experienced the death of a parent, sibling, spouse, friend or other loved one in the six months before their heart attack; almost 20 people had experienced a loss within the past day. The authors calculated the risk of a heart attack as 21 times higher in the first day after the loss of a loved one, and six times higher during the week after such a loss. The study was published today in the American Heart Association's journal Circulation.

While previous studies have shown that the death of a loved one is linked to worsening health over time, the latest study is the first to show that the effects can begin so immediately and strongly after a loss, findings that surprised lead author Elizabeth Mostofsky and her colleagues.

“The risk was high not only the following day, but also remains high for quite some time,” Mostofsky said, noting that the risk was also higher if the person said the loss was moderately or extremely significant to them. Grief also makes blood "stickier" and therefore more likely to clot, Mostofsky says. Acute stress tends to increase levels of the hormones known as catecholamines, she explains, which causes platelets to stick together. If a plaque bursts, the resulting clot is more likely to cut off blood to the heart.

Studies have shown that people can and do suffer from “broken heart syndrome,” called takotsubo, a condition in which heart attacks occur in the face of abrupt, stressful news or events. Scientists aren't entirely sure how shock or grief lead to a heart attack but, most likely, emotional stress boosts levels of stress hormones and other factors that can increase heart rate, blood pressure, blood clotting and other factors that put the heart at risk.

Broken heart syndrome is more common among older women, but in the latest study, the grieving heart attack survivors were mostly younger men. Dr. Cindy Grines, vice president of academic and clinical affairs at the Detroit Medical Center Cardiovascular Institute, noted that many of them had more typical causes of heart attack, such as ruptured plaques or blood clots in their arteries, and might not have experienced classic takotsubo, when heart attacks usually occur with no typical causes.

But she said she doesn't doubt that many of their heart attacks might have been tied to grief. “I have had several patients come in with heart attacks shortly after the death of a spouse,” Grines said, including a 38-year-old man who reported chest pains shortly after witnessing the death of his wife. The man delayed treatment to make funeral arrangements, and when he finally went to the hospital, he had a major blood clot in his artery. “If he had been seen early, started on aspirin and other medications, this clot would not have become so large,” Grines said.

Mostofsky said such cases might be typical among grief-stricken people, who might stop taking medications, delay treatment or dismiss heart attack warning signs after the death of a loved one. “Although they may be experiencing the symptoms of loss, they shouldn't attribute symptoms to stress alone,” Mostofsky said. “They should take this seriously and realize these could be symptoms of a heart attack and they should seek care.”

Dr. Clyde Yancy, chief of cardiology at Northwestern Memorial Hospital, said doctors should take other triggers such as physical activity or episodes of anger into consideration when they are treating patients. “It is sufficiently common that practitioners should be sensitized to its likelihood,” Yancy said. “We should not miss those treatment opportunities as a means of preventing this clustering of events.”

“This [study] suggests that if you add grief to traditional risk factors for coronary artery disease, whether it be smoking, hypertension, or family history, the grief may potentially put you over the edge,” says Eugene Storozynsky, a cardiologist at the University of Rochester Medical Center, in Rochester, New York, who was not involved in the study.

Several questions remain unanswered, however. For instance, the researchers weren't able to determine whether heart-attack risk was affected by the relationship the survivors had with the deceased. Of the 193 participants who provided details, 40 reported losing a parent, child, spouse, or sibling, and 153 lost a friend or more distant relative.

Also, due to a lack of data from angiograms (a type of X-ray), the authors can't rule out the possibility that some of the participants had Takotsubo cardiomyopathy.