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一个主要的生活事件压力源。虽然大多数人会适应失去亲人，但配偶或子女的死亡已被证明会增加随后数月或数年的全因死亡率，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，评估丧亲之痛在多大程度上引发心肌梗死和中风的研究有限。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，其中一项是关于心肌梗死的研究，另一项是关于心脏骤停的研究。这两项研究都依赖于自我报告的亲属死亡的发生和时间，而且都太小，无法确定哪些特征使一些人更容易受到丧亲之痛的影响；目前还没有研究证实丧亲之痛是否会引发中风。这个项目的中心焦点是检验这样一个假设，即心肌梗死和中风的发病率在失去亲人后的几天和几周内急剧升高，并且在随后的几个月和一年中发病率仍然升高。在拟议的研究培训计划中，我们的目标是通过对1991年至2006年期间超过600万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和时间，以及研究人群中心肌梗死或中风的发生时间和发病率，来解决知识上的差距和先前研究的局限性。为了控制未测量的混杂因素，我们还将对队列中所有心肌梗死和脑卒中病例进行嵌套、自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最易受丧亲之痛引发的心血管事件影响的个体的特征。如果丧亲之痛后心血管风险增加，那么一些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治疗，及时关注实际上是心肌梗死和中风发作指标的压力症状

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.