‘Tis the season to… have a heart attack and die

10 December 2018

Here’s some cheery news for you to savour during the festive season: heart-related deaths (known in medical circles as ‘coronary mortality’) reach a peak in December and January.

The phenomenon has been described in the medical literature for almost two decades, ever since a team of US researchers headed up by Dr Robert Kloner plotted monthly rates of death from ischaemic heart disease (damage to the heart resulting from decreased blood supply, usually due to the build-up of cholesterol-laden plaque in the coronary arteries) over 12 years in Los Angeles County.

Their first observation was that there were more cardiac deaths in the winter than in the summer, which was unsurprising as colder temperatures had already been demonstrated to cause changes to blood vessel function and blood clotting that increase the risk of a heart attack.

However, when they broke the monthly data down into day-by-day tallies and plotted them on a graph, they noticed a striking increase in the daily number of heart-related deaths which began in late November with the Thanksgiving holiday, continued escalating through Christmas, peaked on New Year’s Day, and then declined.

The increased death rate on the holidays did not appear to be related to extreme cold, since a) LA has a mild climate year-round and b) there is not much variation in daily minimum temperatures during December and January.

Kloner and his team speculated that the upswing in cardiac deaths during the holiday season might result from either the emotional stress of the holidays (family get-togethers – yay!!!!), or overindulgence in food and alcohol, or both.

Five years later, another team of researchers headed by Dr David Phillips confirmed Kloner and his team’s work in an article cheerily titled ‘Cardiac mortality is higher around Christmas and New Year’s than at any other time: the holidays as a risk factor for death’.

In an editorial published in Circulation in 2004, Kloner jovially dubbed the phenomena the “Merry Christmas Coronary” and “Happy New Year Heart Attack” – I’ll bet he’s the life of every Christmas party.

Phillips’ team found that spikes in daily mortality from both cardiac and noncardiac diseases occurred during the Christmas/New Year’s holiday period, even after making statistical adjustments for known factors such as the effects of extreme cold weather on death rates.

People who died of cardiac causes were found to be more likely to be dead on arrival at hospital, to die in the emergency department, or die as outpatients peaks at Christmas and again at New Year’s. Examining deaths in this specific category, they found a 4.65% higher risk from cardiac causes and almost 5% higher risk of noncardiac mortality – that is, death from any other cause, excluding suicides, homicides, and accidents; all of which also spike during holiday periods.

Examining death certificates from 1973 to 2001, Phillips and his co-authors found that the risk of snuffing it in the holiday season had steadily increased over that time span; in fact, in 1973 people were slightly less likely to die of cardiac causes during the holiday season than at other times.

So what is it about the festive season that makes people more likely to shuffle off their mortal coil?

Phillips and his co-authors considered 10 possible contributing factors:

1. Colder temperatures
2. Respiratory disease, which weakens cardiac patients and increases their risk of dying of cardiac causes
3. Emotional stress associated with the holidays
4. Changes in diet and alcohol consumption
5. Increased air pollution
6. Month boundary effect (deaths generally tend to peak at the beginning of the month, and dip at the end)
7. Misreporting of mortality data
8. Postponement of death (people may ‘hold on’ until an important occasion)
9. Precipitation of death (the holidays may bring on the deaths of people who were going to die anywhere)
10. Inappropriate delay in seeking medical care.

They dismissed the first nine factors for various reasons, and came down in favour of the last explanation, but Kloner, in his editorial, pointed out flaws in their reasoning process that led them to discount the role of diet and alcohol consumption, and increased emotional stress.

While Phillips and his coauthors claimed that overindulging in rich food and booze could not cause the ‘Christmas Coronary’ because the spike in death rates also affects hospital inpatients, Kloner pointed out that patients are often brought gifts of festive food by their visitors. (I would add that Christmas Day hospital menus are also likely to contain richer food than everyday menus.)

And, as Phillips et al acknowledged themselves, the increased death rate was more pronounced in people who were not hospital patients. As Kloner wrote, weight gain, increased salt intake (all those pretzels, chips and processed meats!), fatty meals and excess alcohol all increase the risk of cardiac events by overloading the heart, impairing endothelial function and, in the case of booze, precipitating atrial fibrillation – a potentially fatal disruption to the heart’s rhythm.

As for emotional stress, which Phillips and his coauthors dismissed because the spike in cardiac deaths is also observed in Alzheimer’s patients whom, they assume, are unaware of it being a holiday at all, Kloner points out the rather obvious point that their stress level may still be increased by being forced into unfamiliar or noisy environments, without any comprehension of why this is happening.

And for the rest of us, there’s the stress of socialising with family, in-laws and out-laws, some of whom we’d rather poke a fork in our own eyes than spend the day with; buying gifts that we can’t afford for people we may not even like; and having to drive in holiday traffic or travel at a time of year when everyone is stressed and grumpy (anyone seen Planes, Trains and Automobiles?).

So, how can we dodge the Merry Christmas Coronary and Happy New Year Heart Attack?

Here are my tips for surviving – quite literally – the holiday season:

1. Set clear boundaries when it comes to spending time with people who push your buttons. Just about everyone has that relative or in-law who manages to drive them completely bonkers – the sister-in-law who disapproves of all your parenting choices; the uncle who shoves his political views down your neck, and of course, all the relatives who have no comprehension of your dietary choices. You already know from past experience how long you can spend in these people’s company before you begin to unravel, so set limits on the time you’re going to spend with them, and make sure you have an exit strategy planned. If you’re travelling to spend time with family and literally can’t leave the house, at least find another room that you can decamp to so that you can regain your composure after the umpteenth person asks you where you’re getting your protein from.
2. Remember that the purpose of holiday get-togethers is to spend time with people you care about (hopefully!) not to eat yourself into a food coma. Prepare a healthy spread if you’re hosting others, or take food with you that meets your dietary needs if you’re not. Choose one or two ‘treat foods’ that you normally wouldn’t indulge in, rather than sampling everything on the table. Will Aunt Milly really write you out of her will if you don’t eat her world famous pavlova? Remember, you’re the one who has to wake up in your body the day after the Christmas Day pig-out!
3. Go easy on the booze. After the first drinkies or 2, the most famous effect of alcohol – lowering your inhibitions – kicks in, and you’ll find yourself not only drinking more than you intended, but throwing your diet resolutions against the wall. The pleasure of overindulgence lasts just minutes; the pain of regret continues for hours or even days!
4. Stick with your normal self-care routines throughout the holiday season, even if you have to cut them short. It’s better to do 2 minutes of your meditation practice, or 10 sit-ups, than to skip exercise and meditation altogether. There’s something about ‘breaking the chain’ that makes it much harder to get back into healthy routines when all the partying has finished and January 1 rolls around. On the other hand, even small acts of self-care help to maintain your identity as a person who exercises each day, meditates each day or makes healthy food choices each day.
5. And if you, or anyone you’re with during the festive season, do experience symptoms that may indicate a heart attack (indigestion-like pain that won’t go away, pain in your jaw or down your arm, sweating, dizziness, nausea, shortness of breath, a sensation of constriction in the chest – like an elephant is sitting on you – and/or a feeling of impending doom), call an ambulance immediately. Time is of the essence when dealing with a heart attack; just a few minutes delay can literally make the difference between life and death.

The bottom line is that we have much more control over our health outcomes than most people like to acknowledge; we just need to make the conscious choice to exercise that control.

Need some help with staying on track over the Silly Season? Join December’s EmpowerEd Deep Dive webinar, “Surviving the Holiday Season Without Blowing Your Healthy Habits”… or watch the recording afterward. Activate your free 1 month trial of EmpowerEd today, and start enjoying all the benefits of membership instantly!