Bereavement and Cardiovascular Events: A Nationwide Prospective Study in Sweden

描述(由申请人提供)：亲属的死亡被认为是主要的生活事件压力源。尽管大多数人都会适应这种损失，但事实证明，配偶或孩子的死亡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)和中风的发生率。在失去亲人的最初几周，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，评估丧亲引发心肌梗死和中风的程度的研究有限。只有两项研究考察了丧亲是否会在亲人去世后的几天和几周内引发心血管事件，其中一项是关于心肌梗塞的研究，另一项是关于心脏骤停的研究。这两项研究都依赖于自己报告的亲属死亡的发生和时间，而且都太小，无法确定使一些人更容易受到丧亲影响的特征；还没有研究考察丧亲是中风的触发因素。这个项目的中心焦点是检验这样一种假设，即在失去亲人后的几天和几周内，心肌梗死和中风的发病率急剧上升，并且在随后的几个月和一年中，发病率保持在较高水平。在拟议的研究培训计划中，我们旨在通过对1991至2006年间跟踪调查的600多万瑞典人进行前瞻性队列研究，解决先前研究的知识差距和局限性，使用登记数据识别每个人的一级亲属、亲属的发生和死亡的时间，以及研究人群中心肌梗死或中风的时间和发病率。为了控制未测量的混杂因素，我们还将在队列中所有的心肌梗死和中风病例中进行嵌套的、自匹配的病例交叉分析。这项研究的完成将有助于确定风险增加的时间和最容易受到丧亲引发的心血管事件影响的个人特征。如果丧亲后有更高的心血管风险，几个干预目标可能是适当的，例如鼓励社会支持和遵守预防性药物，及时关注压力症状，这些症状实际上是心肌梗塞和中风发病的指标。 以及药物干预，以减少丧亲期间有害的生理变化。

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.