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Original Investigation |

Increased Risk of Acute Cardiovascular Events After Partner Bereavement:  A Matched Cohort Study

Iain M. Carey, MSc, PhD1; Sunil M. Shah, MBBS, MSc, FFPH1; Stephen DeWilde, MBBS, MD, FRCGP1; Tess Harris, MBBS, MSc, MD, MRCGP1; Christina R. Victor, MPhil, PhD2; Derek G. Cook, MSc, PhD1
[+] Author Affiliations
1Division of Population Health Sciences and Education, St George’s University of London, London, England
2School of Health Sciences and Social Care, Brunel University, Uxbridge, England
JAMA Intern Med. 2014;174(4):598-605. doi:10.1001/jamainternmed.2013.14558.
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Importance  The period immediately after bereavement has been reported as a time of increased risk of cardiovascular events. However, this risk has not been well quantified, and few large population studies have examined partner bereavement.

Objective  To compare the rate of cardiovascular events between older individuals whose partner dies with those of a matched control group of individuals whose partner was still alive on the same day.

Design, Setting, and Participants  Matched cohort study using a UK primary care database containing availale data of 401 general practices from February 2005 through September 2012. In all, 30 447 individuals aged 60 to 89 years at study initiation who experienced partner bereavement during follow-up were matched by age, sex, and general practice with the nonbereaved control group (n = 83 588) at the time of bereavement.

Exposures  Partner bereavement.

Main Outcomes and Measures  The primary outcome was occurrence of a fatal or nonfatal myocardial infarction (MI) or stroke within 30 days of bereavement. Secondary outcomes were non-MI acute coronary syndrome and pulmonary embolism. All outcomes were compared between the groups during prespecified periods after bereavement (30, 90, and 365 days). Incidence rate ratios (IRRs) from a conditional Poisson model were adjusted for age, smoking status, deprivation, and history of cardiovascular disease.

Results  Within 30 days of their partner’s death, 50 of the bereaved group (0.16%) experienced an MI or a stroke compared with 67 of the matched nonbereaved controls (0.08%) during the same period (IRR, 2.20 [95% CI, 1.52-3.15]). The increased risk was seen in bereaved men and women and attenuated after 30 days. For individual outcomes, the increased risk was found separately for MI (IRR, 2.14 [95% CI, 1.20-3.81]) and stroke (2.40 [1.22-4.71]). Associations with rarer events were also seen after bereavement, including elevated risk of non-MI acute coronary syndrome (IRR, 2.20 [95% CI, 1.12-4.29]) and pulmonary embolism (2.37 [1.18-4.75]) in the first 90 days.

Conclusions and Relevance  This study provides further evidence that the death of a partner is associated with a range of major cardiovascular events in the immediate weeks and months after bereavement. Understanding psychosocial factors associated with acute cardiovascular events may provide opportunities for prevention and improved clinical care.

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