Risk of acute myocardial infarction after the death of a significant person in one's life: the Determinants of Myocardial Infarction Onset Study.
BACKGROUND
Acute psychological stress is associated with an abrupt increase in the risk of cardiovascular events. Intense grief in the days after the death of a significant person may trigger the onset of acute myocardial infarction (MI), but this relationship has not been systematically studied.


RESULTS
We conducted a case-crossover analysis of 1985 participants from the multicenter Determinants of Myocardial Infarction 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 with its expected frequency based on each patient's control information, defined as the occurrence of deaths in the period from 1 to 6 months before infarction. Among the 1985 subjects, 270 (13.6%) experienced the loss of a significant person in the prior 6 months, including 19 within 1 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 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.
Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Room 423, Boston, MA 02215, USA.
Elizabeth
E
Mostofsky
Malcolm
M
Maclure
Jane B
JB
Sherwood
Geoffrey H
GH
Tofler
James E
JE
Muller
Murray A
MA
Mittleman
D000368:Aged; D000786:Anger; D018592:Cross-Over Studies; D005190:Family / Q000523:psychology; D005260:Female; D006117:Grief; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D009679:Nuclear Family / Q000523:psychology; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D017805:Widowhood / Q000523:psychology / Q000706:statistics & numerical data*