The Truth Behind More Holiday Heart Attacks By Katherine Kam

Why cardiac problems spike during the holidays and how to stay heart healthy.

Your heart may leap with delight at the electronic gizmo or emerald bracelet that you’ve just unwrapped from under the Christmas tree. But you can’t say the same for that nasty holiday surprise known as the “Merry Christmas coronary” or “Happy Hanukkah heart attack.”

For many years, researchers have been intrigued by a disturbing pattern: Deadly heart attacks increase during the winter holiday season. One study even found distinct spikes around Christmas and New Year’s Day.

“We certainly know that there are certain risk factors for coronary artery disease. There’s obviously smoking, hypertension, dyslipidemia [high cholesterol], diabetes, lack of exercise, and age,” says Robert A. Kloner, MD, PhD, a researcher at Good Samaritan Hospital in Los Angeles and a professor at the Keck School of Medicine at the University of Southern California.

“But we’re also learning that there are certain triggers for cardiovascular events,” he adds, “including time of the year and seasons. If we can get a true handle on the seasonal variation, we could knock down death from coronary disease.”

Heart Attack Weather?

Coronary artery disease stems from atherosclerosis, a condition in which fatty plaques narrow the arteries to the heart. When a plaque ruptures, it can trigger a blood clot that leads to a heart attack.

In a national 2004 study published in Circulation, researchers at the University of California, San Diego, and Tufts University School of Medicine examined 53 million U.S. death certificates from 1973 to 2001. They discovered an overall increase of 5% more heart-related deaths during the holiday season. When researchers looked at individual years, they found varying increases in cardiac deaths for every holiday period they studied, except two.

Doctors have long known that cold weather is hard on the heart. Blood vessels constrict, which raises blood pressure. Blood also clots more readily. Frigid temperatures increase strain on the heart, and too much physical exertion can worsen the burden and trigger a heart attack. For example, doctors have treated many patients whose heart attacks followed strenuous snow shoveling.

Holiday Heart Attack Triggers

But cold extremes don’t really explain why fatal heart attacks peak on Christmas and New Year’s Day, especially among the most rapidly stricken patients. According to the Circulation study, “The number of cardiac deaths is higher on Dec. 25 than on any other day of the year, second highest on Dec. 26, and third highest on Jan. 1.”

Adding to the mystery, why do holiday heart attacks shoot up consistently across the country, even in balmy climes such as Los Angeles, where winter weather stays mild and no one ever wields a snow shovel?

In Kloner’s own research, he found one-third more coronary artery disease deaths in December and January than in June through September during a 12-year period in Los Angeles County.

In the Circulation study, researchers suggested people might delay getting treatment because they don’t want to disrupt Christmas and New Year’s festivities. Kloner, who did not participate in this study, agrees. “People just tend to put off seeking medical help during the holidays. They tend to wait till afterwards, which I think is a mistake,” he says. Or holiday travelers might take longer to find competent medical care, which heightens the risk. Also, hospitals may be short-staffed on major holidays.

Kloner believes other factors may play a role, such as emotional stress and overindulgence. During the holidays, legions of Americans eat too much and drink more alcohol -- while ditching their exercise routine. Needless to say, this combo isn’t healthy for the heart. “People tend to gain weight during the holiday season and take in more salt, which can put additional stress on a weakened heart,” according to Kloner.

Preventing Holiday Heart Attacks

While researchers are still trying to pinpoint the exact reasons for the Christmas coronary, Kloner recommends these common-sense measures during this special time of year:

Pile on the layers. Try to avoid exposure to very cold temperatures. Dress warmly.

Take a load off. Steer clear of heart stressors, including too much physical exertion (especially snow shoveling), anger, and emotional stress.

Make good choices. Avoid excess salt and alcohol. Too much drinking -- for example, binge drinking -- can lead to atrial fibrillation, an abnormal heart rhythm in which disorganized electrical signals cause the heart’s two upper chambers to contract irregularly. Atrial fibrillation increases the risk of stroke, heart attack, and heart failure.

Get a shot. Consider getting a flu vaccination. Infection and fever put extra stress on the heart.

Breathe. Go indoors during air pollution alerts but try to avoid breathing smoke from wood-burning fireplaces. If you’re visiting another home during the holidays, sit as far away as you can from a burning fireplace. Ultra-fine particles in the air can be bad for the heart.

Get help. If you feel chest pain or other symptoms, call 911 for emergency help. The stakes are high. So give yourself and your family a gift this season. Don’t postpone treatment because you don’t want to spoil the holiday merrymaking.

SOURCES:

Robert A. Kloner, MD, PhD, researcher with Good Samaritan Hospital in Los Angeles; professor at the Keck School of Medicine at the University of Southern California.

Phillips, D.P. et al., Circulation. 2004; 110:3781-3788.

Kloner, R.A. “Circulation. 2004;110:3744-3745.

National Heart, Lung and Blood Institute: “What Is Atrial Fibrillation?”