Hooray for the holidays!
'Tis the season for celebration, laughter and love. Festivities can bring all of these and so much more, including stress, anxiety, overindulgence and, in extreme cases, heart trouble.
The relentless push to arrange the perfect dinner, buy the perfect gift and host the perfect party can transform the season of joy into a holiday nightmare. Add to this marathon dinners, office celebrations, extended couch time and late nights -- a merry vortex of adrenaline, fatigue, food and alcohol excess do you have.
It should come as little surprise that the heart attack rate peaks during and immediately after the holidays. Clinicians now recognize the so-called holiday heart syndrome, an umbrella term to describe a constellation of cardiac anomalies -- some of them less serious and some life-threatening -- precipitated by overconsumption of food and drink, too much excitement, stress and sleep deprivation.
Sources of stress vary -- work deadlines, holiday preparations, travel, familial obligations -- and can lead to interpersonal conflict, infusing the season with anger, sadness and even hopelessness. Emotional stress can elevate blood pressure and heart rate, and it can unlock a cascade of chemical changes that lead to abnormal inflammatory responses. These responses may affect the immune system and insulin levels, disrupting the body's ability to regulate sugar.
Intense emotional stress can precipitate acute cardiac events or exacerbate underlying cardiovascular problems. For example, hormones released during intense emotional or physical exertion can disrupt pre-existing atherosclerotic plaque in the arteries of the heart. When plaque breaks off, it can cause the formation of a blood clot, damaging the vessel and leading to heart attacks and strokes. In such scenarios, stress can be the proverbial straw that breaks the camel's back, setting off a cascade of physiological changes in the heart that culminate in a heart attack.
Depression, which is marked by chronic, low-grade stress, can get worse during the holidays. Holiday festivities can underscore loneliness and isolation, and can fuel sadness for people going through a traumatic change, such as divorce or loss of a loved one. More people report depression during the winter months. Research shows that people with acute depression have more than double the risk for heart attacks compared to people without depression. A 2012 study found that people mourning the loss of a loved one have higher risk for heart attacks, particularly if they have pre-existing cardiovascular disease.
Other, more insidious stressors include crushing work deadlines, ballooning holiday expenses and the sheer intensity of juggling multiple priorities. Albeit of slightly different origins, these stressors can drive up cardiac risk through the same underlying chemical and physiologic mechanisms.
Acute stress can unlock the body's fight-or-flight response, a survival mechanism preserved from the dawn of human history that allows us to flee predators or fight intruders. When stress occurs all the time or too often, it can lead to chronically elevated levels of the fight-or-flight hormone adrenaline and put the body in a constant state of alert, fueling exaggerated reactions, such as road rage or shopping-line fury.
The evidence is unequivocal -- such "stress" states can take a toll on the heart and the body. A Swedish study showed that people who reported a sudden, short-term increase in workload, like a high-pressure deadline -- Thanksgiving dinner for 12, anyone? -- were six times more likely to suffer a heart attack in the next 24 hours. Similarly, research shows sitting in heavy traffic can also fuel heart attack risk.
A 2013 study revealed that people who had an outburst of anger had a 2.4-fold increase in heart attack risk in the two hours after the episode. Waving through the driver who's trying to cut you off is not merely magnanimous but may be better for your heart.
All of these dangers are powerfully amplified by pre-existing heart disease or multiple risk factors. A 2013 study in the American Journal of Medicine showed that people with previous heart attacks who had a high level of anxiety had an elevated risk of dying from any cause within the first three years of their heart attack.
Aside from unleashing hormonal changes that directly elevate heart attack risk, stress and depression can also boost the risk indirectly by driving people to engage in unhealthy coping behaviors, such as smoking, drug use, alcohol abuse and binge eating. We are all guilty of coping in maladaptive ways every now and then, but the abundance of food and drink during the holidays and the million excuses to avoid the gym make such unhealthy indulgences ever harder to avoid.
A Heart-Healthy H oliday S urvival G uide
At the table, try substituting one dish on your traditional menu for a heart-healthy alternative. Decrease the stress of going it alone for the perfect holiday dinner by asking your guests to make or bring a dish.
Try to stay active after your meal! If going for a run after dinner is far too ambitious, consider an evening stroll or slipping on your dancing shoes as an easy and fun way to rev up your metabolism.
Limit alcohol intake and fill your glass only as a meal companion or for toasting. Several studies have shown that to receive any cardioprotective benefits of red wine, moderation in alcohol consumption, as in all else, is key. A 2015 study published in the journal Epidemiology found the risk of heart attacks goes up within an hour of consuming alcohol among people who don't drink daily.
Individual responses to stress vary. They are predicated on multiple factors, including genes, psychological resilience and social support systems. But here's the good news: Some of that psychological reserve can be built up through consciously cultivating positive thinking and mindfulness, actively engaging in social activities and pursuing intellectually stimulating hobbies. So buddy up and schedule a 5K race or a longer run. Make a New Year's resolution now, and let it be your holiday gift to yourself.
If you find yourself far away from loved ones this season, consider volunteering for a chance to meet new people. Research shows that increasing empathy and altruistic behaviors can lower cardiovascular risk over time. Sharing your talents, energy and time with others is a wonderfully healthy way to forge bonds with your community. It is a gift that keeps on giving and a true testament to the holiday spirit.
Dr. Priya Umapathi is a postdoctoral clinical and research fellow in cardiology at the Johns Hopkins University School of Medicine. Her research interests are in cellular mechanisms for heart damage and recovery, with a special focus on the impact of inflammation, stress and obesity on heart disease.
Dr. Erin Michos is a cardiologist and associate professor of medicine at the Johns Hopkins University School of Medicine with a joint appointment in epidemiology at the Johns Hopkins Bloomberg School of Public Health. She is the associate director of preventive cardiology for the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Her research interests focus on general preventive cardiology, cardiovascular health in women, vitamin D and management of lipid disorders.