Bereavement and Cardiovascular Events: A Nationwide Prospective Study in Sweden

丧亲之痛和心血管事件：瑞典的一项全国性前瞻性研究

• 批准号: 8593634
• 负责人: Elizabeth Mostofsky
• 金额: $ 5.45万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8593634
• 关键词: Acute; Address; Attention; Bereavement; Blood Pressure; Brain hemorrhage; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Cessation of life; Characteristics; Child; Clinical; Coagulation Process; Cohort Studies; Data; Diagnosis; Disease; Epidemiology; Event; First Degree Relative; Generations; Goals; Heart Arrest; Heart Rate; Hemostatic Agents; Hospitalization; Incidence; Individual; Inflammation; Inflammatory; Intervention; Ischemic Stroke; Knowledge; Life; Medical History; Myocardial Infarction; Parents; Patient Self-Report; Pharmaceutical Preparations; Physiological; Population Study; Preventive; Prospective Studies; Public Health; Relative (related person); Research; Research Training; Risk; Siblings; Social support; Spouses; Stress; Stroke; Sudden Death; Sweden; Symptoms; Testing; Time; United States; Woman; Work; base; cardiovascular risk factor; cohort; experience; heart disease risk; hemodynamics; high risk; interest; loved ones; men; mortality; prospective; public health relevance; response; sex; stressor

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：亲属的死亡被认为是一个主要的生活事件压力源。虽然大多数人会适应这种损失，但配偶或子女的死亡已被证明会增加随后几个月和几年的全因死亡率，并可能增加心肌梗死（MI）和中风的发病率。在丧亲之痛的最初几周，凝血、心率、血压和炎症都会发生变化。这些生理反应与心脏病和中风的风险增加有关，但在亲人去世后的几天和几周内，评估丧亲之痛引发MI和中风的程度的研究有限。只有两项研究调查了丧亲之痛是否会在亲人去世后的几天和几周内引发心血管事件，其中一项研究是关于心肌梗死的，另一项研究是关于心脏骤停的。这两项研究都依赖于自我报告的亲属死亡的发生和时间，而且两者都太小，无法确定使一些人更容易受到丧亲之痛影响的特征;一直没有研究将丧亲之痛作为中风的触发因素。该项目的中心焦点是检验这样一个假设，即在亲属死亡后的几天和几周内，心肌梗死和中风的发病率急剧升高，并且在随后的几个月和几年内发病率仍然升高。在拟议的研究培训计划中，我们的目标是通过对1991年至2006年的600多万瑞典人进行前瞻性队列研究，以确定每个人的一级亲属，亲属死亡的发生时间，以及研究人群中MI或中风的发生时间和发病率，来解决知识差距和先前研究的局限性。为了控制未测量的混杂因素，我们还将在队列中的所有MI和卒中病例中进行嵌套的、自身匹配的病例交叉分析。这项研究的完成将有助于确定高风险的时间和个人的特点，最容易受到心血管事件引发的丧亲之痛。如果丧亲后心血管风险增加，则可能有几个适当的干预目标，例如鼓励社会支持和遵守预防性药物治疗，及时关注实际上是MI和中风发作指标的压力症状 和药物干预，以减少在丧亲期间有害的生理变化。

项目成果

Association Between High Levels of Physical Exertion, Anger, and Anxiety Immediately Before Myocardial Infarction With Mortality During 10-Year Follow-Up.

心肌梗塞发生前的高水平体力消耗、愤怒和焦虑与 10 年随访期间死亡率之间的关联。

• DOI: 10.1016/j.jacc.2015.06.1317
• 发表时间: 2015
• 期刊: Journal of the American College of Cardiology
• 影响因子: 24
• 作者: Smeijers,Loes;Mostofsky,Elizabeth;Tofler,GeoffreyH;Muller,JamesE;Kop,WillemJ;Mittleman,MurrayA
• 通讯作者: Mittleman,MurrayA

Anxiety and anger immediately prior to myocardial infarction and long-term mortality: Characteristics of high-risk patients.

心肌梗死前的焦虑和愤怒和长期死亡：高危患者的特征。

• DOI: 10.1016/j.jpsychores.2016.12.001
• 发表时间: 2017
• 期刊: Journal of psychosomatic research
• 影响因子: 4.7
• 作者: Smeijers,Loes;Mostofsky,Elizabeth;Tofler,GeoffreyH;Muller,JamesE;Kop,WillemJ;Mittleman,MurrayA
• 通讯作者: Mittleman,MurrayA

Healthcare-Related Regret among Nurses and Physicians Is Associated with Self-Rated Insomnia Severity: A Cross-Sectional Study.

护士和医生中与医疗保健相关的遗憾与自评失眠严重程度有关：一项横断面研究。

• DOI: 10.1371/journal.pone.0139770
• 发表时间: 2015
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Schmidt,RalphE;Cullati,Stephane;Mostofsky,Elizabeth;Haller,Guy;Agoritsas,Thomas;Mittleman,MurrayA;Perneger,ThomasV;Courvoisier,DelphineS
• 通讯作者: Courvoisier,DelphineS