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Heart Health, Explained

Loss: Heart Health and the Loss of a Loved One

We all know that it can be heartbreaking to lose a loved one. Now a new study published in the Journal of the American Medical Association (JAMA) Internal Medicine and reported February 24th, 2014, by NBC News finds that the heartbreak can be more than symbolic. The researchers found that the rates of heart attack and stroke increased within 30 days of a partner’s death, compared to rates for those who did not lose a partner.

Loss of a Loved One Q&A

Q: Can you explain how the researchers conducted this study, and what they found, specifically?

A: The research team conducted a study using information available in a large United Kingdom primary care database of more than 100,000 persons, 60 to 89 years old. The investigators determined the number of heart attacks and strokes in patients who had just had a significant other/partner die. They compared those numbers to a control group of patients who did not have a recent death of a significant other. The researchers found a two-fold increase in the risk of having a heart attack or stroke during the first month after the partner’s death. This increase in risk was the same for both women and men. The risk of heart attack and stroke returned to that of the control group following the first month. These findings demonstrate that patients have a higher risk of having a major cardiovascular event in the first month after a loved one’s death.

Reference: JAMA Internal Medicine, Increased Risk of Acute Cardiovascular Events After a Partner Bereavement, February 24th, 2014.

Q: We understand that there have been previous studies showing that grief can lead to adverse physiological responses. Does anyone know why bereavement increases risks for heart attack and stroke?

A: Although we do not have a single study that completely identifies why bereavement increases the risk for a heart attack and stroke, it is likely a combination of several factors. For example, in the year prior to a loved one’s death, patients are much less likely to seek routine medical assessment for high blood pressure and cholesterol, which are major risk factors for heart attack and stroke. In addition, during the 3 months around the loved one’s death, patients are less likely to take their own prescribed cardiovascular medications. Not surprisingly, blood pressure and heart rate have been demonstrated to be higher in patients experiencing grief. Increased blood pressure and heart rate place greater strain on the heart and the blood vessels. Finally, depression causes changes in body chemistry that increase stress hormone, inflammation markers, and clotting factors that can lead to increased blood clotting and damage to the heart blood vessel wall. These conditions can lead to plaque rupture and heart attack or stroke.

Q: Are there ways that people experiencing grief can remediate their stress and take steps to lower cardiovascular risks?

A: There are several things patients can do to help during stressful life events. One of the most important is to take advantage of the restorative benefits of sleep. Sleep can reduce levels of stress, resulting in better control of weight, blood pressure and inflammation, and improvement in symptoms of depression. All of these risk factors have been shown to be associated with heart disease and stroke. Keeping in contact with your health care provider after a stressful life event and taking blood pressure and cholesterol medications as prescribed are important interventions to lower cardiovascular risk, especially in patients experiencing grief. Regular exercise has been shown to signal release of chemicals called endorphins in the brain that help a person relax and feel better. Moreover, exercise has been shown to help protect against the physical effects of stress and grief. Regular exercise also reduces the risk factors for developing a heart attack or stroke by its beneficial effect on blood pressure and cholesterol. Although it can be challenging during times of grief, it is very important to maintain a healthy diet with fruit, vegetables, nuts, and lean meat to reduce the risk of future cardiovascular events. Finally, patients often benefit from seeing a psychologist or mental health professional who can provide evaluation, education and counseling to patients. This can assist in dealing with stress, depression and anger, and help in obtaining and using social support, all of which can greatly affect heart health and recovery.

Additional References
  1. Shah SM, Carey IM, et al. Impact of partner bereavement on quality of cardiovascular disease management. Circulation. 2013; 128:2745 - 53.
  2. Buckley T, Mihailidou AS, et al. Haemodynamic changes during early bereavement: potential contribution to increased cardiovascular risk. Heart Lung Circ. 2011; 20(2):91-8.
  3. Wallén NH, Goodall AH, Li N, Hjendahl P. Activation of haemostasis by exercise, mental stress and adrenaline: effects on platelet sensitivity to thrombin and thrombin generation. Clinical Science. 1999; 97,:27–35

Answers to your questions on timely topics in cardiac care to help make sense of research reports in the media. The series includes questions on your heart and the effect of medications, exercise, diet, and hormones.

Team Specialist

David Nicholson, DO, FACC Non-interventional Cardiologist OhioHealth Healthcare System Columbus, Ohio

Q&A Editor

Teresa Caulin-Glaser, MD, FACC, FAACVPR System Vice President, Heart & Vascular Services OhioHealth Healthcare System, Columbus, Ohio

Heart Health Explained is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health.

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.