The risk of a myocardial infarction (MI) may increase during the days and weeks after the death of a close loved one, according to research reported in Circulation: Journal of the American Heart Association.

A study of 1,985 adult MI survivors showed that after a significant person's death, risk of having an MI:

• Increased to 21 times higher than normal within the first day.
• Were almost six times higher than normal within the first week.
• Continued to decline steadily over the first month.

"Caretakers, healthcare providers, and the bereaved themselves need to recognize they are in a period of heightened risk in the days and weeks after hearing of someone close dying," said Murray Mittleman, M.D., Dr.P.H., a preventive cardiologist and epidemiologist at Harvard Medical School's Beth Israel Deaconess Medical Center and School of Public Health's epidemiology department in Boston, Mass.

Researchers also found that the increased risk of MI within the first week after the loss of a significant person ranges from one per 320 people with a high MI risk to one per 1,394 people with a low MI risk.

The study is first to focus on MI risk during the first few days and weeks after someone close died.

Grieving spouses have higher long-term risks of dying, with heart disease and strokes accounting for up to 53 percent of deaths, according to previous research.

As part of the multicenter Determinants of MI Onset Study, researchers reviewed charts and interviewed patients while in the hospital after a confirmed MI between 1989 and 1994. Patients answered questions about circumstances surrounding their heart attack, as well as whether they recently lost someone significant in their lives over the past year, when the death happened and the importance of their relationship.

Researchers used a case crossover design to compare patients over the past six months. The approach eliminated the possible confounding factors of comparing different people.

The researchers estimated the relative risk of MI by comparing the number of patients who had someone close to them die in the week before their heart attack to the number of deaths of significant people in their lives from one to six months before their MI. Psychological stress such as that caused by intense grief can increase heart rate, blood pressure and blood clotting, which can raise chances of a heart attack.

At the beginning of the grieving process, people are more likely to experience less sleep, low appetite and higher cortisol levels, which can also increase MI risks.

Grieving people also sometimes neglect regular medications, possibly leading to adverse heart events, said Elizabeth Mostofsky, lead author of the research. "Friends and family of bereaved people should provide close support to help prevent such incidents, especially near the beginning of the grieving process."

Similarly, medical professionals should be aware that the bereaved are at much higher risk for MI than usual.

"During situations of extreme grief and psychological distress, you still need to take care of yourself and seek medical attention for symptoms associated with a heart attack," Mittleman said.

Future studies are needed to make more specific recommendations based on the study, Mittleman said.

Co-authors are: Elizabeth Mostofsky, M.P.H, Sc.D.; Malcolm Maclure, Sc.D.; Jane Sherwood, R.N.; Geoffrey Tofler, M.D.; and James Muller, M.D.

The National Institutes of Health funded the research.