Bereavement can take toll on health, not just emotions

Shortly after a partner dies, spouse more prone to heart attack, stroke

In the month following the death of a spouse or partner, people are twice as likely to have a heart attack or stroke as others their age. Scientists find that while the grieving period coincides with tangible medical risks during these critical weeks, the danger subsequently fades.

The study adds to research that has established bereavement as a time of medical risk to be monitored and, if possible, treated. In a finding published in Circulation in 2012, researchers detected a 21-fold increase in heart attack incidence in the 24 hours after the death of a significant person in their lives — such as a spouse, parent, child or friend — compared with the risk one to six months after such a loss.

The new analysis, published February 24 in JAMA Internal Medicine, taps into a U.K. health registry to track the fate of more than 30,000 people ages 60 to 89 whose partner or spouse had died. The researchers also identified more than 83,000 people who weren’t bereaved but who matched the survivors in age and gender. Sunil Shah of St. George’s University of London and colleagues found that the absolute risk of heart attack or stroke was low in both groups: 0.16 percent in the bereaved group during the month after their loss versus 0.08 percent among the others in a month. Nevertheless, that amounted to a doubling.

The study “breaks new ground,” says social epidemiologist S.V. Subramanian of the Harvard School of Public Health, because it shows that stroke and heart attack seem to underlie an increase in mortality during bereavement seen in earlier studies. The new findings also confirm the acute nature of bereavement risk, he says. Studies collectively show little long-term danger, he says.

Subramanian says that in addition to the immediate stress and shock of a loss, survivors might also be weakened by previous months or years of taking care of a sick spouse. And in the haze following the death of a partner, daily self-care such as taking medication may suffer. “There’s a mental health component here.” The increased risk, he says, “is probably a combination of things.”

Some scientists have examined the effects of bereavement stress at the molecular level. At the University of Sydney, researchers compared blood components of 80 recently bereaved people with those from 80 others who hadn’t suffered a loss. The bereaved had higher levels of inflammatory cells and clotting factors, the researchers reported in 2012 in the European Journal of Preventive Cardiology.

Psychiatrist Roland von Känel of the University of Bern in Switzerland says stress-induced inflammation may destabilize plaques in arteries, causing them to break loose from vessel walls. Such plaque rupture, which can also result from heightened blood pressure associated with grief, leads to clotting, he says. Blood clots in coronary arteries can cause heart attacks; in the brain, they can cause strokes.

In people with borderline cardiovascular disease, it remains unknown whether bereavement stress is enough to push them into a medical crisis, Subramanian says. But with further studies, he says, “we might see that this could be the tipping point.”

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