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Ho Ho ... Heart Attack?

Holidays Bring High Risk for Heart Trouble

It's the holiday season! Time for cozy gatherings with family and friends, glittering winter landscapes and holiday lighting, and ― perhaps dearest of all ― traditional holiday meals and treats.

But the influx of food, family and functions can do more damage than the obvious drain on finances and time. The winter holiday season can actually raise the risk of heart trouble. While the reasons for this are not fully defined, research points toward poor diet or excessive eating, emotional stress and a tendency to abandon healthful habits during this busy time of year. It's easy to jingle all the way to higher risk for having a cardiovascular event.

The Gift that No One Wants

Murray A. Mittleman, MD"Why heart attacks increase during the winter holiday season is unclear," said Murray A. Mittleman, MD, Director of BIDMC's Cardiovascular Epidemiology Research Unit. "While colder weather may play a role, studies have shown that the spike in heart events during the holiday season occurs even in warmer climates."

One study revealed a 33 percent increase in coronary-related deaths during the months of December and January.

Conducted at the Heart Institute Research Laboratory at Good Samaritan Hospital in California, the study focused on coronary deaths in Los Angeles County during a 12-year time period. Since this eliminated cold weather as a factor in the increased number of deaths, holiday-related stress remains under suspicion.

While we don't have definitive data about the specific causes of holiday heart attacks and risks, there are certain holiday behavior patterns that can increase the rise of the cardiac event.

Eating Your Heart Out

It's no secret that holiday celebrations offer many temptations to overindulge. Many holiday foods, such as gravy, ham, or baked desserts, are high in saturated fats or sodium. Overindulgence in these foods can increase cholesterol levels or blood pressure, making it more difficult for blood to flow through arteries and upping the chance of a blockage.

What you may not know is that eating a heavy holiday meal may affect you even after you've pushed away from the table.

"Research shows that anyone with coronary-artery disease or high cholesterol has a heightened risk for heart attack for up to one day after eating a heavy meal," said Mittleman.

Mittleman participated in a study, "Heavy Meals May Trigger Heart Attacks," led by Francisco Lopez-Jimenez, MD, currently the Director of the Cardiometabolic Program at the Mayo Clinic. This study, which focused on nearly 2,000 former heart attack patients, found that 10 percent of them suffered a coronary within 26 hours after eating a heavy meal.

Anne Riley, MDA heavy meal may cause a heart attack for several reasons. After a large meal, blood pressure rises as the digestive process kicks in, which increases pressure on artery walls. This can cause the heart to work harder. In addition, a high-fat meal can cause insulin levels to spike, which stiffens the coronary artery. All of these physical responses can raise the risk for an arterial blockage from rupture of plaque buildup or by a blood clot.

"People often change their eating habits during the holidays," said Anne Riley, MD, a BIDMC cardiologist. "For those with congestive heart failure (CHF), salty foods can cause fluid retention and high blood pressure, which place added stress on an already weakened heart."

The Seasonal Stress Factor

Holiday stress can do more than wear down your patience. Juggling shopping, decorating, and cooking with holiday events and school vacations can take an emotional and subsequent physical toll on heart health. This escalates if there's an additional stress from a death, illness or emotional distress in the family.

In fact, emotional stress - such as feelings of anxiety, anger, fear, bereavement or depression - preceded heart attacks in 14 to 18 percent of patients, according to a study conducted by Mittleman and fellow researchers from BIDMC's Institute for Prevention of Cardiovascular Disease.

"Social interaction can boost your health and feelings of well-being as long as it's positive," Mittleman explained. However, "If tempers escalate at a family function, the best thing you can do is distance yourself."

Physical stress can also present risks.

"We often see people in the hospital's emergency department after a snowstorm," said Edward Ullman, MD, a BIDMC emergency physician specializing in emergency cardiology. "These are frequently individuals who are not in great physical condition, perhaps 50 to 60 years old, who have a significant coronary event when they are shoveling snow."

When it's cold out, arteries clamp down and blood pressure can go up, according to Ullman. The incidence of heart attacks rises in the early morning, which is when most folks are shoveling snow.

Respiratory Conditions and Medications

Holiday merrymaking with groups of people in confined areas presents ample opportunities to pass along colds, viruses and the flu. The flu and respiratory infections trigger inflammation in the body, which can make plaque within arteries more likely to rupture, blocking arteries and raising the risk for heart attack.

The good news is that getting a flu vaccine may protect you from more than just the flu. A recent study conducted in the UK found that a flu vaccination resulted in a 19 percent decrease in heart-attack risk during the following year.

If you are already fighting a cold, avoid taking decongestants if you have heart disease or high blood pressure.

"While decongestants are designed to constrict blood vessels in the nose and airways, they also narrow blood vessels throughout the body," said Ullman, "which can raise your blood pressure and increase your risk of heart attack or stroke."

Some decongestants, such as pseudoephedrine, act as stimulants and raise the risk of irregular heartbeat in patients with atrial fibrillation, who are already at higher risk for cardiac dysfunction.

Minimizing Risk while Making Merry

"Why hearts attacks increase during the winter holiday season is not entirely clear," said Mittleman, "but the fact that they do means that you need to pay particular attention to your health during the cold weather months."

Here are some tips to follow to keep you going through the holiday season and beyond:

  • Enjoy special meals in moderation. Avoid or limit high-fat items - gravy, fattier cuts of meat, and buttery side dishes - while including fresh vegetables and fruit.
  • Drink alcoholic beverages sparingly, avoiding multiple drinks at one sitting.
  • Maintain a regular exercise schedule to avoid weight gain and reduce stress. In frigid or bad weather, consider indoor options, like a gym, mall-walking or a fitness DVD.
  • If you do shovel, take your time. Proceed slowly and carefully and don't over-exert yourself.
  • Don't skip your medications. If you're traveling, pack twice as many in case your flight gets delayed and keep them in your carry-on bag if you're traveling by air. Be sure to bring a list of medications, health issues, allergies and physicians with you, and keep this in your purse or wallet.
  • If you are older than 65 or have heart-disease risk factors, get a flu vaccine.
  • If you have congestion in your nose or chest, avoid decongestants and use natural methods such as steam or neti pots.

Don't allow the holidays to break your heart. Stay in tune with your body and be aware of any drastic changes, whether physical or emotional. By limiting intake of indulgent foods, taking time to de-stress, and seeking treatment for health issues as soon as they appear, you can ensure a holiday that's not only heart-warming but heart-healthy, too.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, contact your doctor.

Posted December 2011

Contact Information

CardioVascular Institute at
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215