Risk of Acute Myocardial Infarction After the Death of a Significant Person in One’s Life: The Determinants of Myocardial Infarction Onset Study

Study Questions:

To what degree does intense grief in the days after the death of a significant person trigger the onset of acute myocardial infarction (MI)?

Methods:

A case-crossover analysis was conducted in 1,985 participants from the multicenter Determinants of Myocardial Infarction Onset Study, who were interviewed during index hospitalization for an acute MI between 1989 and 1994. The observed number of deaths in the days preceding MI symptom onset was compared with its expected frequency based on each patient’s control information, defined as the occurrence of deaths in the period from 1-6 months before infarction.

Results:

Among the 1,985 subjects, 270 (13.6%) experienced the loss of a significant person in the prior 6 months, including 19 within one day of their MI. The incidence rate of acute MI onset was elevated 21.1-fold (95% confidence interval, 13.1-34.1) within 24 hours of the death of a significant person, and declined steadily on each subsequent day. The absolute risk of MI within 1 week of the death of a significant person is one excess MI per 1,394 exposed individuals at low (5%) 10-year MI risk and one per 320 among individuals at high (20%) 10-year risk.

Conclusions:

The authors concluded that grief over the death of a significant person was associated with an acutely increased risk of MI in the subsequent days. The impact may be greatest among individuals at high cardiovascular risk.

Perspective:

The grief reaction over the death of a loved one or a significant support person includes anxiety and associated stress, depression, and anger, each of which has been associated with acute coronary syndromes (ACS). While the absolute risk of an MI in the bereaved is low, the frequency of ACS that includes unstable angina and stress cardiomyopathy would likely be several-fold incident MIs.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies

Keywords: Depression, Myocardial Infarction, Infarction, Depressive Disorder, Acute Coronary Syndrome, Cross-Over Studies, Takotsubo Cardiomyopathy, Risk Factors, Grief, Incidence, Disclosure, Cardiovascular Diseases, Confidence Intervals, Hospitalization


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