Ischaemic heart disease

Simple prescription for avoiding post-bereavement MI


A combination of commonly used preventive medications has been shown to reduce the risk of MI during the first month of bereavement when the risk of a debilitating cardiovascular event is at its peak.

The research, presented at this year’s CSANZ conference by Professor Geoffrey Tofler from Royal North Shore Hospital in Sydney and Heart Research Australia, was awarded best abstract in the prevention category.

Described as ‘a great achievement’ with significant potential to reduce heart attack risk by panel discussants the study showed that the combination of low dose metoprolol (25mg) and aspirin (100mg) reduced cardiovascular risk markers and was associated with reduced anxiety and depression compared to placebo.

According to Professor Tofler, his previous work showed the risk of MI increased as much as four fold in the first six months of bereavement.

It also showed that the physiological responses to bereavement combined with behaviour modification during the traumatic time, can cause changes that predispose people to ischaemia, arrhythmia, plaque disruptions and thrombosis leading to infarction and sudden death.

“The main study findings showed the active medication, used in a low dose once a day, successfully reduced spikes in blood pressure and heart rate, as well as positive changes in blood clotting tendency,” Professor Tofler said.

The drug combination, taken over six weeks, also significantly reduced symptoms of anxiety and depression compared to placebo as measured by a questionnaire taken at baseline and cessation.

Intriguingly these trends continued in the intervention group when patients were assessed again six weeks off therapy suggesting the possibility of a legacy effect, Professor Tofler said.

The reduced anxiety and depression symptoms are both ‘reassuring’ and ‘encouraging’ for treating the potential mental health impact in bereavement, he added.

The investigators studied 85 recently bereaved spouses or parents who were not on any heart rate or antiplatelet drugs or had any type of severe illness.

Forty-three were given placebos, but 42 received daily doses of the beta blocker and aspirin, for six weeks. Their heart rate and blood pressure was carefully monitored, and they underwent blood tests to assess blood clotting changes.

The investigators carefully monitored the psychological state of the participants throughout the trial.

“My hope would be that the findings from here would be an incentive for doctors to tell subjects at increased risk, patients who are tachycardic or hypertensive for instance, that during early acute bereavement they could benefit from the treatment as a short-term preventative therapy.”

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