The death of a relative is recognized as a major life event stressor. Although most people adjust to the loss, the death of a spouse or child has been shown to increase the rate of all- cause mortality in subsequent months and years, and may increase the rate of myocardial infarction (MI) and stroke. In the early weeks of bereavement, there are changes in clotting, heart rate, blood pressure and inflammation. These physiologic responses have been associated with an increased risk of heart disease and stroke, but there is limited research to evaluate the extent to which bereavement triggers MI and stroke in the days and weeks following the death of a loved one. Only two studies have examined whether bereavement triggers cardiovascular events in the days and weeks immediately following the death of a loved one, including one study on MI and one on sudden cardiac arrest. Both studies relied on self- reported occurrence and timing of the death of relatives and both were too small to identify characteristics that make some people more vulnerable to the effects of bereavement;there has been no study to examine bereavement as a trigger of stroke. The central focus of this project is to test the hypothesis that there is a sharply elevated incidence f myocardial infarction and stroke in the days and weeks following the loss of a relative, and that the incidence remains elevated in the subsequent months and year. In the proposed research training plan, we aim to address the gaps in knowledge and limitations of prior research by conducting a prospective cohort study of over 6 million Swedish individuals followed from 1991 to 2006 using register data to identify each individual's first-degree relatives, the occurrence an timing of deaths of relatives, and the timing and incidence of MI or stroke in the study population. To control for unmeasured confounders, we will also perform a nested, self-matched case-crossover analysis among all cases of MI and stroke in the cohort. Completion of this study will help to identify the timing of heightened risk and the characteristics of individuals tht are most susceptible to cardiovascular events triggered by bereavement. If there is a heightened cardiovascular risk following bereavement, several targets of intervention may be appropriate, such as encouraging social support and compliance with preventive medications, providing timely attention to symptoms of stress that are in fact indicators of MI and stroke onset and pharmacologic interventions to reduce harmful physiologic changes in the bereavement period.

Public Health Relevance

The death of a spouse or child has been shown to increase the rate of all-cause mortality in subsequent months and years, and may increase the rate of heart attacks and stroke. However, only two studies have examined whether bereavement triggers cardiovascular events in the days and weeks immediately following the death of a loved one, and both relied on self- reported occurrence and timing of the death of relatives. In the proposed research training plan, we aim to address the gaps in knowledge and limitations of prior research by using national registers to conduct a nationwide prospective cohort study of over 6 million Swedish individuals followed from 1991 to 2006.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Postdoctoral Individual National Research Service Award (F32)
Project #
1F32HL120505-01
Application #
8593634
Study Section
Special Emphasis Panel (ZRG1-F16-L (20))
Program Officer
Stoney, Catherine
Project Start
2013-09-01
Project End
2014-08-31
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
1
Fiscal Year
2013
Total Cost
$54,453
Indirect Cost
Name
Beth Israel Deaconess Medical Center
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02215
Mittleman, Murray A; Mostofsky, Elizabeth (2014) Exchangeability in the case-crossover design. Int J Epidemiol 43:1645-55
Wilker, Elissa H; Wu, Chih-Da; McNeely, Eileen et al. (2014) Green space and mortality following ischemic stroke. Environ Res 133:42-8
Mostofsky, Elizabeth; Penner, Elizabeth Anne; Mittleman, Murray A (2014) Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis. Eur Heart J 35:1404-10