Risk of Acute Myocardial Infarction after Death of a Significant Person in One's Life: The Determinants of MI Onset Study
Background—Acute psychological stress is associated with an abrupt increase in the risk of cardiovascular events. Intense grief in the days following the death of a significant person may trigger the onset of acute myocardial infarction (MI), but this relationship has not been systematically studied.
Methods and Results—We conducted a case-crossover analysis of 1985 participants from the multicenter Determinants of MI Onset Study interviewed during index hospitalization for an acute MI between 1989 and 1994. We compared the observed number of deaths in the days preceding MI symptom onset to its expected frequency based on each patient's control information, defined as the occurrence of deaths in the period from 1 to 6 months prior to infarction. Among the 1985 subjects, 270 (13.6%) experienced the loss of a significant person in the prior six months, including 19 within 1 day of their MI. The incidence rate of acute MI onset was elevated 21.1 fold (95%CI 13.1 to 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 1 excess MI per 1394 exposed individuals at low (5%) 10-year MI risk and 1 per 320 among individuals at high (20%) 10-year risk.
Conclusions—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.
- Received August 11, 2011.
- Accepted November 28, 2011.
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