Increased Risk of Acute Cardiovascular Events After Partner Bereavement: A Matched Cohort Study

Study Questions:

What are the rates of cardiovascular events between older individuals whose partner dies with those of a matched control group of individuals whose partner was still alive on the same day?

Methods:

This was a matched cohort study using a UK primary care database containing available data of 401 general practices from February 2005 through September 2012. In all, 30,447 individuals ages 60-89 years at study initiation who experienced partner bereavement during follow-up were matched by age, sex, and general practice with the nonbereaved control group (n = 83,588) at the time of bereavement. The primary outcome was occurrence of a fatal or nonfatal myocardial infarction (MI) or stroke within 30 days of bereavement. Secondary outcomes were non-MI acute coronary syndrome (ACS) and pulmonary embolism (PE). All outcomes were compared between the groups during prespecified periods after bereavement (30, 90, and 365 days). Incidence rate ratios (IRRs) from a conditional Poisson model were adjusted for age, smoking status, deprivation, and history of cardiovascular disease.

Results:

Within 30 days of their partner’s death, 50 of the bereaved group (0.16%) experienced an MI or a stroke compared with 67 of the matched nonbereaved controls (0.08%) during the same period (IRR, 2.20; 95% confidence interval [CI], 1.52-3.15). The increased risk was seen in bereaved men and women and attenuated after 30 days. For individual outcomes, the increased risk was found separately for MI (IRR, 2.14; 95% CI, 1.20-3.81) and stroke (IRR, 2.40; 95% CI, 1.22-4.71). Associations with rarer events were also seen after bereavement, including elevated risk of non-MI ACS (IRR, 2.20; 95% CI, 1.12-4.29) and PE (IRR, 2.37; 95% CI, 1.18-4.75) in the first 90 days.

Conclusions:

The authors concluded that the death of a partner is associated with a range of major cardiovascular events in the immediate weeks and months after bereavement.

Perspective:

This study reports a marked increase in the incidence of cardiovascular events in older individuals in the months after the death of their partner. This association was found separately for MI, stroke, ACS, and PE. Overall, this analysis confirms the potential of major life events, such as bereavement, to lead to marked short-term increases in the risk of cardiovascular events likely related to the result of adverse physiological responses associated with acute grief. A better understanding of psychosocial factors associated with acute cardiovascular events may provide opportunities for prevention and improved clinical care. The most appropriate and feasible measure for now seems to be ensuring good long-term management of cardiovascular risk among individuals before and after bereavement through lifestyle modification and medications.

Clinical Topics: Acute Coronary Syndromes, Prevention, Vascular Medicine, Smoking

Keywords: Stroke, Acute Coronary Syndrome, Myocardial Infarction, Follow-Up Studies, Receptor, Insulin, Pulmonary Embolism, Risk Factors, Smoking, Incidence, Death, Cardiovascular Diseases, Confidence Intervals, Primary Health Care


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