By Trevor Stokes
Reuters

Bottling up emotions is thought to harm both mind and body, but a new study suggests that the opposite extreme may be no better.

In a study of thousands of heart attack patients, those who recalled having flown into a rage during the previous year were more than twice as likely to have had their heart attack within two hours of that episode, compared to other times during the year.

"There is transiently higher risk of having a heart attack following an outburst of anger," said study author Elizabeth Mostofsky, postdoctoral fellow with the Cardiovascular Epidemiology Research Unit at Harvard Medical School in Boston.

The greater the fury - including throwing objects and threatening others - the higher the risk, Mostofsky's team reports in The American Journal of Cardiology. The most intense outbursts were linked to a more than four-fold higher risk while milder bouts of anger were tied to less than twice the risk.

"The association is consistently stronger with increasing anger intensity; it's not just that any anger is going to increase your risk," Mostofsky told Reuters Health

The data came from a group of 3,886 patients who were part of a study between 1989 and 1996 to determine what brought on their heart attacks.

Within four days of having a myocardial infarction - the classic "heart attack" - participants were asked about a range of events in the preceding year, as well as about their diets, lifestyles, exercise habits and medication use.

A total of 1,484 participants reported having outbursts of anger in the previous year, 110 of whom had those episodes within two hours of the onset of their heart attacks.

Participants recalled their anger on a seven-point scale that ranged from irritation to a rage that caused people to lose control.

The researchers found that with each increment of anger intensity, the risk of heart attack in the next two hours rose. That risk was 1.7 times greater after feeling "moderately angry, so hassled it shows in your voice;" and 2.3 times greater after feeling "very tense, body tense, clenching fists or teeth" and 4.5 times greater after feeling "enraged! lost control, throwing objects, hurting yourself or others."

The most frequent causes of anger outbursts that participants recalled were family issues, conflicts at work and commuting.

Although the research cannot prove that the angry outbursts led to the heart attacks, the results "make sense," according to Dr. James O'Keefe Jr, a cardiologist at St. Luke's Hospital in Kansas City who wasn't involved in the research.

Anger is an emotion that releases the fight-or-flight-response chemicals epinephrine and norepinephrine, he said.

Those hormones raise our blood pressure, our pulse, constrict blood vessels, make blood platelets stickier (increasing the risk of blood clots), which O'Keefe says could be one way anger may be associated with increased heart risk.

"Contrary to the urban myth that it's best to express anger and get it out there, expressing anger takes a toll on your system and there's nothing really cathartic about it," O'Keefe told Reuters Health.

"(Anger) serves no purpose other than to corrode the short and long-term health of your heart and blood vessels," he said.

In the study, patients on blood pressure medications known as beta blockers had a reduced chance of having a heart attack following an angry outburst, Mostofsky's team notes in their report.

The authors say that finding suggests doctors might consider using those drugs preventively in people at risk of heart attack and prone to anger.

In discussing other possibilities for protecting people at risk, the researchers also write that during the 1990s when the data were collected, not enough study participants were on the newer statin drugs to determine their potential effects on heart attack risk.

Similarly, the number of participants who were on antidepressants was too low to tell whether they would have made a difference.

Regular exercise, Mostofsky and her colleagues write, has been shown to lower overall heart attack risk. Though they found no differences in the link between angry outbursts and short-term heart attack risk among regular exercisers in the study, they conclude that maintaining an active lifestyle couldn't hurt.

The study is part of a broader field of research looking at managing the effects of emotional states on cardiovascular systems, said Donald Edmondson, assistant professor of behavioral medicine at Columbia University Medical Center in New York, who studies heart attack survivors but was not involved in the new work.

"People prone to angry outbursts or more broadly, who are prone to anxiety, depression or other intense emotions should be aware that this is something that impacts their cardiovascular system," Edmondson told Reuters Health.

By Sharon Begley
Reuters
Thousands of heart attack victims every year have none of the notorious risk factors before their crisis - not high cholesterol, not unhealthy triglycerides. Now the search for the mystery culprits has turned up some surprising suspects: the trillions of bacteria and other microbes living in the human gut. 

In a study released on Wednesday, scientists discovered that some of the bugs turn lecithin - a nutrient in egg yolks, liver, beef, pork and wheat germ - into an artery-clogging compound called TMAO. They also found that blood levels of TMAO predict heart attack, stroke or death, and do so "independent of other risk factors," said Dr Stanley Hazen, chairman of cellular and molecular medicine at the Cleveland Clinic's Lerner Research Institute, who led the study.

That suggests a TMAO test could enter the arsenal of blood tests that signal possible cardiovascular problems ahead. "TMAO might identify people who are at risk (for heart attacks and strokes) despite having no other risk factors," Hazen said.

The discovery also suggests a new approach to preventing these cardiovascular events: altering gut bacteria so they churn out less TMAO.

The study joins a growing list of findings that link human "microbiota" - microbes in the gut, nose and genital tract, and on the skin - to health and disease. Research has shown that certain species of gut bacteria protect against asthma, for instance, while others affect the risk of obesity. Last week scientists reported that circumcision alters bacteria in the penis, and that this change (not only the anatomical one) helps protect men from HIV/AIDS, probably by reducing the number of bacteria that live in oxygen-free environments such as under the foreskin.

"It's very strong work," Dr Martin Blaser of New York University Langone Medical Center, a pioneer in studies of the microbiota, said of the TMAO study. "They show clearly that human microbiota play a key role in producing TMAO, suggesting new approaches to prevention and treatment" of cardiovascular disease.

Normal cholesterol, fatal heart attack
The new study builds on a 2011 discovery by the Cleveland Clinic team that, in lab mice, gut bacteria turn lecithin in food into TMAO, or trimethylamine-N-oxide, causing heart disease. In addition, they found, people with high levels of TMAO are more likely to have heart disease.

But that research left two questions hanging: Do human gut bacteria trigger the lecithin-to-TMAO alchemy, like those in mice? And do high levels of TMAO predict heart attacks and stroke in people many years out, not simply mark the presence of cardiovascular disease at the time of the blood test?

To answer the first question, Hazen and his colleagues had 40 healthy adults eat two hard-boiled eggs, which contain lots of lecithin. Just as in lab mice, TMAO levels in the blood rose. After a week of broad-spectrum antibiotics, however, the volunteers' TMAO levels barely budged after they ate eggs, the researchers reported in the New England Journal of Medicine.

"That showed that the intestinal bacteria (which antibiotics kill) are essential for forming TMAO," said Hazen.

Next, to see whether TMAO predicts cardiovascular events, the researchers measured its levels in 4,007 heart patients. After accounting for such risk factors as age and a past heart attack, they found that high levels of TMAO were predictive of heart attack, stroke and death over the three years that the patients were followed.

Moreover, TMAO predicted risk more accurately than triglyceride or cholesterol levels, Hazen said. And it did so in people without substantial coronary artery disease or dangerous lipid levels as well as in sicker patients.

Specifically, people in the top 25 percent of TMAO levels had 2.5 times the risk of a heart attack or stroke compared to people in the bottom quartile.

The reason TMAO is so potent is that it makes blood cholesterol build up on artery walls, causing atherosclerosis (hardening of the arteries) and, if the buildup ruptures and blocks an artery, stroke or heart attack.

Earlier this month, the Cleveland Clinic researchers reported that gut bugs also transform carnitine, a nutrient found in red meat and dairy products, into TMAO, at least in meat eaters. Vegetarians made much less TMAO even when eating carnitine as part of the study, suggesting that avoiding meat reduces the gut bacteria that turn carnitine into TMAO, while regular helpings of dead animals encourages their growth and thus the production of TMAO.

More studies are needed to show whether TMAO reliably predicts cardiovascular crises, and does so better than other blood tests. Experts disagree on how many people have no other risk factors but would be flagged by TMAO. Dr Gordon Tomaselli, chief of cardiology at Johns Hopkins University School of Medicine and past president of the American Heart Association, guesses it is less than 10 percent or so of the people who eventually have heart crises.

Someone with high levels of TMAO could reduce her cardiovascular risk by eating fewer egg yolks and less beef and pork. But someone with a two-eggs-a-day habit but low TMAO probably has gut microbes that aren't very adept at converting lecithin to TMAO, meaning she can eat eggs and the like without risking a coronary.

Just as statins control unhealthy cholesterol, prebiotics (compounds that nurture "healthy" gut microbes) or probiotics (the good bugs themselves) might control unhealthy TMAO. For now, however, no one knows which prebiotics or probiotics might do that. In one study, probiotics actually increased TMAO-producing bacteria - "not what you want," Hazen said.

Neither will popping antibiotics work: bacteria become resistant to the drugs. Developing compounds that crimp the ability of the bacteria to turn lecithin into TMAO, Hazen said, is more likely to succeed.

Losing your job can give you a heart attack – quite literally.

Duke University researchers have found that unemployment significantly raises the risk of a heart attack. And that risk goes up with each job loss and with increasing time spent unemployed, according to a study published in the Archives of Internal Medicine.

In fact, one job loss raised the risk of a heart attack by 35 percent, while four job losses raised the risk by 63 percent. The unemployed were at greatest risk of a heart attack within the year following a layoff or firing.

“Looking at a lifetime of exposure to a social stressor such as unemployment – the number of times a person has lost a job or the amount of time they’re without a job – there’s an independent association with heart attacks,” says the study’s lead author Matthew E. Dupre, an assistant professor of at Duke and a senior fellow at the university’s Center for the Study of Aging.

Dupre says he and his colleagues were somewhat surprised by their results, since they took into account known  and suspected risk factors, like high blood pressure and loss of health insurance.

“The fact that the associations remained largely unchanged despite accounting for more than a dozen suspected risk factors was somewhat unexpected,” he says. “Changes in income, health insurance, health behaviors, physical health status, and the like had little impact on the risks related to unemployment. Instead, we found that the risks associated with multiple job losses were of the magnitude of other established risk factors, such as smoking, hypertension, and diabetes.”

For the new study, the researchers scrutinized the health and work histories of 13,451 adults aged 51 to 64. Detailed histories covered a full 18 years, during which study volunteers suffered a total of 1061 heart attacks.

At the outset, 14 percent of the volunteers were unemployed. During the course of the study 69.7 percent lost one or more jobs.

Heart experts said that the study adds to the mounting evidence that certain kinds of stressors can ramp up the risk of a cardiovascular event.

“This is adding to what we know with regards to the triggers of cardiovascular events,” says Dr. John Schindler, an assistant professor of medicine at the University of Pittsburgh Medical Center. “Many years ago we thought of this as a random process. Now we see there are real triggers, whether environmental or perceived stress.”

Recent studies have turned up numerous emotional triggers, including frustration, depression, and anxiety, Schindler says. “And all of those go along with unemployment,” he adds.

So, what is it about job loss that might raise the risk of a heart attack?

“There are likely multiple mechanisms which link significant socioeconomic stress, including becoming unemployed, to an increased risk of cardiovascular events,” says Dr. Eliot Corday Professor of Cardiovascular Medicine and Science at the University of California, Los Angeles, Eliot Corday Professor of Cardiovascular Medicine and Science at the University of California, Los Angeles, and co-director of the UCLA preventive cardiology program. “These include sustained activation of the part of the nervous system involved with stress and stress-related hormones, decrements in heart healthy behaviors, avoiding preventive health visits and measures, and not seeking prompt medical attention when there are early warning signs.”

What the study shows, experts say, is that you need to pay extra attention to your heart in times of stress, such as job loss.

“My conclusion is that we should always be focused on our hearts since cardiovascular disease is potentially such a potentially deadly disease,” Schindler says. “But since we’re at greater risk the first year we lose a job, at that time we should be even more diligent about cardiovascular health.”

Future research could examine whether emotional support could help reduce risk.

“Whether the cardiovascular risk related to unemployment and multiple job losses could also be reduced by psychological support or enhanced social resources will require further study,” Fonarow says.

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Heart attacks more deadly in winter -- but it's not the cold

'Broken heart' syndrome can be triggered by stress, grief

By Jennifer Nelson
MyHealthNewsDaily

Getting a flu shot this season may not only greatly lower your risk of influenza this year, it may also lower your risk of heart disease, a new review from Canada suggests.

Results show that people who received the flu vaccine were 50 percent less likely to experience a heart attack or stroke, and 40 percent less likely to die from one, compared with people in the unvaccinated control group.

The flu vaccine could be an important way to maintain heart health and ward off strokes and heart attacks, the researchers said. They presented their findings at a cardiovascular disease research meeting today (Oct. 28) in Toronto.

In the study, Dr. Jacob Udell, a cardiologist at Women's College Hospital and the University of Toronto, and colleagues looked at four previous studies involving a total of more than 3,000 people — some with previous heart disease, and some without such conditions. Participants in all the studies were randomly assigned to receive a flu vaccine, no vaccine or a placebo injection, and were tracked for the following year. The average age of the subjects was 60; most included were over 30, according to Udell.

The findings suggest that “perhaps that the flu vaccine is a heart vaccine,” Udell said.

During the year after vaccination, there were 187 cases of heart attacks or stokes, including 65 deaths.

Regardless of whether study participants had a history of heart disease, those who got the flu vaccine were less likely to have cardiovascular events, or die them from.

While the reason for the link is not exactly clear, Udell said it may be that when people develop heart disease, some factor "tips them over the edge," such as plaque clogging arteries, or lower levels of oxygen as a result of the flu.

The flu vaccine may stop this "tipping" by preventing flu, or by actually breaking up plaque in the arteries. “Either one is very provocative, and it's important to drill down and get the answer,” Udell said.

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Dr. Sarah Samaan, a cardiologist and director of the Women’s Cardiovascular Institute at Baylor Heart Hospital in Plano, Texas, said the key to the link may be in reducing inflammation.

When someone gets the flu, blood levels of inflammatory substances rise, and inflammation of the blood vessels can trigger heart attacks.

“This happens because inflammation can make cholesterol plaques in the blood vessels unstable," Samaan explained. Unstable plaques are more likely to develop tiny cracks, which can cause blood clots to form. Such clots can block blood flow within arteries, causing a heart attack (if the blood vessel supplies the heart) or a stroke (if the artery feeds the brain), she said.

Udell cautioned that the 50 percent reduction in cardiovascular events seen in the study may be a high number, but said that even if the flu vaccine reduced the risk of a heart attack or stroke by just 10 percent, vaccination could make a major dent in saving lives.

A larger study could help firm up the numbers, he said, and he hopes to start one.

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In 2005, Joel Bizon went into Maine Medical Center in Portland for a routine surgery. When the surgeon came out to report that the procedure was a success, Joel's wife Cyndy was relieved. For the next few hours, she sat by the waiting room phone, anxious to be reunited with her husband.

Instead, Cyndy got the news that Joel had taken a turn for the worse and had suffered a heart attack while in recovery.

 "I just remember dropping the phone in shock," says Cyndy.  

The next few days were a blur. Cyndy set up camp in the hospital, visiting her husband in the cardiac intensive care unit as often as she could. She wasn't eating or sleeping well. Eventually the stress would take a toll on her. Two days into Joel's recovery, Cyndy walked up to the nurses’ station to check in. No one could have predicted what happened next.

"I remember feeling dizzy... and trying to grab the counter. I remember a curtain of black that I couldn't shake away coming down,” Cyndy says.  

Head nurse Cathy Palleschi recalls hearing a loud thud. She came out of her office to find Cyndy on the floor and immediately called a code. The team who attended to Cyndy was able to revive her and get her heart back to its normal rhythm within a couple of minutes. But Palleschi says she doesn't think Cyndy would be here today if the episode had occurred elsewhere.  

A rush of hormones
Instead of being by her husband’s side as he recovered, Cyndy ended up in the cardiac ICU herself, right across the hall. After ruling out a blockage, a stroke, and an epileptic seizure, doctors determined Cyndy had suffered something called "broken heart" syndrome.

"If someone cuts Joel, I bleed; we are that close. I could understand the stress that I was under, but didn't realize that it could have that kind of an effect on my heart," Cyndy says.   

Dr. Ilan Wittstein, a cardiologist at Johns Hopkins Medicine, is part of the team that first coined the term “broken heart” syndrome, also known as stress cardiomyopathy. According to Wittstein, the syndrome got its name because a lot of patients suffer from it after the death of a loved one. But it's not always triggered by grief.

"There's a wide variety of emotions that can cause this," says Wittstein. Extreme fear, anxiety and even being surprised can lead to stress cardiomyopathy, he says. In patients with “broken heart” syndrome, the extreme stress of an event triggers the brain to send a signal to the adrenal glands, located on the kidneys and responsible for regulating stress in the body. The adrenal glands release a surge of hormones that then rush to the heart, essentially paralyzing the muscle and causing it to shut down.  

Wittstein says although the symptoms often mimic that of a typical heart attack — chest pain, shortness of breath — “broken heart” syndrome is different. Heart attacks are caused by a blockage, but in “broken heart” syndrome, the muscle of the heart becomes dysfunctional and doesn't squeeze normally.  And unlike a classic heart attack, the heart is only temporarily "stunned" and usually recovers with no permanent damage. But Wittstein points out that in severe cases, a patient can end up in heart failure.

“When I’m asked, can you die of a broken heart, I say… absolutely, yes, you can,” says Wittstein.

Registry tracks condition
Wittstein's research has found that up to 90 percent of broken-heart patients are women, most of whom are post-menopausal and over the age of 55. Estrogen improves blood flow to the heart and experts suggest that as women age and levels of the hormone decline, he tissue surrounding their hearts becomes more susceptible to stress hormones.  For this reason, a stressful event at age 25 — when estrogen levels are high — may not have the same effect on the heart as later in life, Wittstein says

Dr. Wittstein’s team at Johns Hopkins has set up a stress cardiomyopathy registry. This initiative has been following people with the condition since 1999, in an attempt to get a clearer picture of the features of “broken heart” syndrome. With a broader understanding of the causes and clinical features, doctors can begin to identify particular risk factors and, one day, may be able to intervene early enough to prevent it from occurring in the first place.  

Cyndy, now 64, and Joel, 63, both fully recovered. They enjoy long walks and golfing, making regular exercise an important part of their lives. They also visit the hospital each year on the anniversary of Cyndy's episode, calling it their "re-birth day." For Cyndy, the most important message of their story is, "to be thankful for every moment that you have because it can be snatched away from you so quickly, without you having any warning." 

For more information about the Johns Hopkins University Initiative for Stress Cardiomyopathy go to: http://www.hopkinsmedicine.org/asc/

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By MyHealthNewsDaily staff

For heart attack survivors, living close to a roadway may be hazardous for their health, a new study suggests.

The results show that heart attack survivors who lived about 300 feet (100 meters) from a major roadway at the time of their heart attack were 27 percent more likely to die over the next 10 years compared with those who lived at least 3,200 feet (1,000 m) from a roadway.

Those who lived between 650 to 3,200 feet (200 to 1,000 m) away from a roadway had a 13 percent higher risk of dying in 10 years.

Exposure to air pollution and traffic noise from the roadway may explain the link, said study researcher Dr. Murray Mittleman, a physician at Beth Israel Deaconess Medical Center in Boston.

Long-term exposure to air pollution is known to increase the risk of death from heart disease, and some studies have shown exposure to traffic noise increases blood pressure, the researchers said.

The study involved 3,547 people who were hospitalized for a heart attack at 64 medical centers in the United States between 1989 and 1996. Participants' average age at the beginning of the study was 62.

Over a 10-year follow-up period, 1,071 participants died: 63 percent of cardiovascular disease, 12 percent of cancer, 4 percent of respiratory failure and 0.4 percent in traffic accidents.

The closer patients lived to a major roadway, the more likely they were to die during the follow-up period. The results held even after the researchers accounted for factors that could affect a person's risk of death, including age, smoking status, proximity to a hospital and household income.

The researchers said the study was limited in that they don't know whether participants moved after their heart attack, or if new roadways were built closer to participants' homes, but either of these scenarios could affect the results.  For instance, a patient who moved closer to a roadway would have been misclassified in the study.

The American Heart Association suggests clinicians educate their patients on the risks posed by air pollution, and encourage patients with cardiovascular disease to avoid unnecessary exposure to traffic, the researchers said.

The study will be published in the May 8 issue of the journal Circulation.  

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Long commute can hurt your health

Short-term exposure to air pollution -- just a day or a week in some cases -- may kick off a heart attack or stroke, scientists now say.

Two new studies reveal that the risk of heart attack or stroke can jump after high-pollution days, especially for people who already have predisposing health problems.

Up to a week of exposure to most major types of air pollution may be enough to trigger a heart attack, a new analysis published in the latest issue of the Journal of the American Medical Association finds. Heart attack risk went up by almost 5 percent with high carbon monoxide levels and almost 3 percent with higher levels of air particles for up to seven days.

The risk of stroke jumped 34 percent after 24 hours of exposure to moderate air pollution, according to a study published in the latest issue of the Archives of Internal Medicine.

The increase in stroke risk was greatest within 12 to 14 hours of exposure to fine particulate matter and was most strongly associated with pollution from traffic.

No one knows exactly how much pollution will trigger a heart attack or brain attack, but experts suggest that vulnerable people protect themselves by minimizing time spent breathing air contaminated with a heavy dose of fine particles.

“What we can say is that exposure to a high level of pollution is harmful to people at risk,” said Dr. Hazrije Mustafic, the lead author of the analysis that examined data for pollution and heart attack risk in 34 previous studies.

“They must avoid the most polluted places, like highways, for example,” said Mustafic, a cardiologist and a researcher in cardiovascular epidemiology at the University of Paris Descartes, INSERM Unit 970. “We do not know how long of an exposure causes an excess risk of heart attack, but the relationship is linear.”

In other words, Mustaficsaid, as exposure increases, both in terms of time and intensity, so does the risk of a heart attack.   

The best recourse for those with cardiovascular disease may be to keep a close eye on local pollution levels, experts say. And government agencies are making that easier and easier.  The Environmental Protection Agency, for example, has a downloadable app that provides information on local air quality.

While short-term exposures to pollution can’t explain every stroke or heart attack, they do have a significant impact, experts said.

In 2007, for instance, there were 184,000 hospitalizations for stroke in the Northeastern U.S., said Gregory Wellenius, lead author of a paper on stroke risk published in the latest issue of the Archives of Internal Medicine.

“We estimate that 6,000 of those stroke hospitalizations could have been prevented,” Wellenius said.

His research study is the first to look at how short-term exposure to pollution impacts stroke risk. And, even though he found an increased risk, Wellenius is hesitant to offer advice until other studies duplicate his findings.

“This is just one study,” said Wellenius, who performed the research at Harvard’s Beth Israel Deaconess Medical Center and is now an assistant professor of epidemiology at Brown University. “It was done in Boston, a city notable because it has relatively low pollution levels. The study should be replicated in other parts of the country.”

The researchers did find that even moderate amounts of pollution can cause harm, said Roger Peng, an associate professor of biostatistics at the Johns Hopkins School of Public Health.

“They found a pretty sizable effect on ischemic stroke for a range of people at a relatively low level – one that is well under the national air quality standards,” Peng said.

The study is underscoring the point that “there is no safe level,” of pollution Peng added.

The culprit in both studies is particulate matter, tiny bits of material and droplets, known as PM2.5s. The particles come from a variety of sources, including power plants, factories, trucks and cars.

“These are very small particles, about a 30^thof the diameter of a human hair, ” Peng explained.

Peng suggested that people concerned about air quality download from the AIRNow app from the EPA’s website. The app works on both Apple and Android phones and allows users to get pollutant and ozone levels for more than 400 cities across the nation.

On bad air days, people at risk for heart attack or stroke might want to be careful about exercising outside, Peng said.

Other researchers go even further.  

“If you have any kind of cardiovascular risk factor it might be prudent to avoid anything that could make you breath hard and bring more junk into your lungs,” said Patrick Kinney, a professor of environmental health sciences at the Mailman School of Public Health at Columbia University. “The trouble with some of these pollutants is that they can get inside, too.”

The two new studies extend what scientists had already learned about pollution and cardiovascular disease, Kinney said. Earlier research showed that long-term exposure to pollutants could lead to clogged arteries, just as smoking cigarettes can, Kinney said.

While people can try to limit their personal exposure to these tiny particles, the best approach would be to get pollution levels down, Kinney said.

“To me this suggests the need to push for cleaner air,” he added. “If all cars and trucks were electric powered you wouldn’t have to worry as much.”

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The loss of a loved one can literally turn heartache into heartbreak, a new study shows.

Researchers found the risk of a heart attack jumped to 21 times higher than normal in the day following the death of a close relative or friend, according to the study published in the journal Circulation.

And that spike occurred even in people at low risk of heart attack, said the study’s lead author, Elizabeth Mostofsky, a post-doctoral research fellow at the Beth Israel Deaconess Medical Center and the Harvard School of Public Health.

“That’s why this study sends such an important message,” Mostofsky said. “If you see someone dealing with grief you need to recognize if they’re having symptoms of a heart attack. You need to realize that they might not just be dealing with grief, but might need medical attention.”

Between 1989 and 1994, the researchers interviewed 1,985 adult heart attack survivors while the patients were still in the hospital. Their average age was just under 62 and they were followed until 2007. Men seemed to be more affected than women, she added.

"Men have a higher risk than women when they lose a spouse," she explained.

Mostofsky and her colleagues found that the most dangerous time was within the first 24 hours after the death of a close friend or relative, with the risk of heart attack spiking 21 times higher than normal. The risk slowly fell off with time, but was still elevated to six times normal in the week following the death.

While the chance of a heart attack among the bereaved was higher for those with risk factors, it was still significant for those at low risk. And that’s why people need to be aware of the danger, Mostofsky said.

Unfortunately, it’s easy to misinterpret heart attack symptoms such as tightness in the chest, stomach pain, light-headedness, nausea and shortness of breath, as signs of grieving, she added. But someone who is grieving and experiencing these symptoms requires medical attention.

Scientists aren’t sure exactly how intense grief leads to heart attack, but there are some theories.

“People are dealing with depression, anger and anxiety,” Mostofsky said. “That can lead to increases in heart rate and blood pressure. It can also lead to a coagulation response in which the blood is more likely to become sticky and clot and that can lead to a blockage and then a heart attack.”

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by Rachael Rettner
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A woman's risk of having a heart attack may begin to rise even before she is born, a new study suggests, and the findings may help researchers better understand the nature of heart disease in women.

The study found women's risk of having a heart attack increased more than eight times if they had changes in certain genes; these changes were previously found to be brought on by stress experienced in the womb, such as not getting enough nutrients.

"Health really starts in the womb," said study researcher Bas Heijmans, a molecular epidemiologist at Leiden University Medical Center in The Netherlands.

The findings support the idea that conditions during early life, such as the habits of a mother during pregnancy, influence her baby's risk of later developing heart disease, Heijmans said.  Ultimately, the researchers would like to find genetic "signatures " that can tell the tale of someone's early life, such as an exposure to alcohol or cigarette smoke. Those signatures could then be used as markers for the persons' risk of disease later in life, Heijmans said.

The findings are published in the Nov. 17 in the International Journal of Epidemiology.

DNA in early life
The study involved 1,654 participants ages 70 to 82 who hadn't had a heart attack before the study's start. After three years, 122 people had suffered a heart attack. The researchers compared the DNA of these individuals to that of 126 participants who had not experienced a heart attack, but were similar in age and other characteristics.

The researchers looked for changes, called epigenetic changes, in six genes known to be influenced by the in utero environment. During such a change, a chemical "tag" is added to a section of DNA.

They found epigenetic changes in two of the genes were associated with an increased risk of heart attack. Women with a tag on one gene were 2.8 times more likely to have a heart attack, and women with a tag on both genes were 8.6 times more likely to have a heart attack, compared with women who didn't have these changes.

However, more work is needed to validate the results. The new study was conducted in adults, so the researchers don’t know exactly what experiences the participants had during the prenatal period.

Men and women
No association between changes in the genes and heart attack risk was found for men. The researchers aren't sure why this is,but it could be that men tend to have heart attacks at earlier ages than the participants included in the study, masking the effect of the gene changes in the study group, Heijmans said.

Because the study was small, these estimates of increased risk for women should be interpreted with caution, Heijmans said. Larger studies that included a wider range of age groups are needed to determine more accurate risk estimates, Heijmans said.

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Teen athletes at risk for sudden cardiac death may be falling through the cracks because doctors are skipping parts of screening exams, a new study shows.

In pre-season physicals for high school sports, fewer than 6 percent of doctors followed the potentially life-saving screening guidelines suggested by the American Heart Association, according to a report presented at the Heart Association’s annual meeting.

While doctors typically listen to young athletes’ hearts and record blood pressures, they often fail to ask important questions designed to ferret out heart disease risk. For example, 67 percent of surveyed doctors said they didn’t always ask teens whether any family members suffered from heart problems.

Even more alarming – barely half of the physicians were even aware that the AHA guidelines existed.

More than 7 million teens play high school sports, according to Dr. Nicolas Madsen, a cardiology fellow at Seattle Children’s Hospital of the University of Washington. Studies show that sudden death occurs at a rate of one in 30,000 to 40,000. That translates into 175 to 233 deaths each year among high school athletes. 

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Recently, there’s been a push to add more tests, such as electrocardiograms, to the standard student-athlete physical, said Madsen, the study’s lead author. But we can’t know whether those additional tests are necessary until all physicians are following current guidelines to the letter, Madsen added.

For the new study Madsen and his colleagues sent out surveys to every family practice doctor and every pediatrician in Washington State. The response was high with 72 percent of pediatricians and 56 percent of family practitioners returning surveys.

Doctors did most poorly when it came to asking about the heart health of teens and their families.

• 28 percent didn’t always ask if a teen had chest pain during exercise
• 22 percent didn’t always ask if the teen ever experienced unexplained fainting
• 26 percent didn’t always ask about a family history of early deaths
• 67 percent didn’t always ask about a family history of heart disease.

While it’s heartening to see that most doctors did remember to ask about sudden deaths in a teen’s family, it’s distressing to see that more than two thirds of doctors weren’t always asking about a family history of heart disease in their exams, Madsen said.

That means that doctors could be missing families in which there were recognized heart problems, but no one had died.

For Dr. Gaurav Arora the biggest surprise in the new study was the number of physicians who said they didn’t always ask about chest pain or fainting.

“Those are red flags in young athletes,” said Arora, associate director of electrophysiology at the Children’s Hospital of Pittsburgh and an assistant professor of pediatrics at the University of Pittsburgh.

One explanation for the new findings is that there is no single form being used by doctors doing pre-season physicals for student athletes, Arora said. Things would be a lot simpler if everyone used the same screening criteria.

Beyond that, Arora said, “we need better education across the board for all providers doing screening.”

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