Partying may kill you- Study

December 31, 2012

SINGAPORE – For years, researchers have noticed a disturbing pattern during the winter holidays in temperate countries: There would be an increase in the number of deadly heart attacks.

It was initially thought that low temperatures, which constrict blood vessels and restrict blood flow and oxygen to the heart, were largely to blame for the spike.

But recent studies show that other factors related to the holiday season itself, such as overindulgence in food and alcohol, may also play a role.

While doctors in Singapore said they have not observed any spike in heart-related problems and deaths during the holidays, they said this does not mean people should not take care of their hearts, especially those with a history of heart problems.

Two patients told Mind Your Body that festive feasting could have triggered their heart attacks earlier this year during the Chinese New Year.

Mechanic supervisor Stanley Siow, 45, had a heart attack on Jan 23, the first day of the Chinese New Year.

He had been gorging on goodies, such as his favourite bak kwa (barbecued pork).

On New Year’s Eve, he had gone out drinking with friends after a heavy reunion dinner with his parents and siblings, returning home at only 3am.

The next day, he went visiting as usual, but at about 4pm, while he was climbing a flight of stairs, he had sudden sharp chest pains and began sweating profusely.

A friend took him to hospital, where he had an emergency angioplasty. The procedure enlarges a narrowed blood vessel using a balloon-tipped catheter.

Another patient, who asked to be known as Mr Tan, had a heart attack on Feb 7. It happened an hour into a football game and after two to three weeks of rich and decadent buffets to celebrate Chinese New Year.

The 57-year-old, who works in research and development in the food and beverage industry and has a history of high blood pressure, felt a tightening in his chest and nausea. He, too, needed angioplasty in hospital.

Too much merry-making

It was a landmark study published in the reputable journal Circulation in 2004 that punctured a hole in the notion that low temperatures were the main cause of cardiac-related heart attacks during the winter holidays.

The study examined 53 million American death certificates from 1973 to 2001 and found, on average, about 5 per cent more deaths than expected during the two weeks from Dec 25 to Jan 7.

The spike, which was also seen in non-cardiac cases and, in fact, all natural deaths (excluding, for instance, suicides, accidents and murders), was found across the country, even in balmy areas such as Los Angeles, where the winter weather tends to be mild.

This led researchers to conclude that there could be other reasons, such as poorer staffing levels during the festive season, behind the spike, which has been coined Merry Christmas Coronary or Happy New Year Heart Attack.

Another reason could be that ill people put off seeking treatment during the holiday season because they do not want to be party poopers. But that postponement leads to sicker patients, some of whom die when they are finally admitted.

There is also the increased emotional stress of having to deal with friends and relatives and the financial drain of gifts, travelling and entertainment.

Dr Peter Yan, medical director of the Parkway Heart and Vascular Centre, said acute stress can increase the level of hormones called catecholamines, which, in turn, can increase heart rate and blood pressure, stressing the heart.

People also tend to eat too much and drink alcohol in excess during the holidays.

Too much salt increases blood pressure, while too much alcohol can lead to an increase in the level of catecholamines, said DrYan.

Excessive alcohol has also been associated with holiday heart syndrome – irregular, fast heartbeats, such as atrial fibrillation, which can be potentially fatal.

The syndrome may be more common during the holiday season because of the wider availability of alcohol at parties and other celebratory events, said Dr Dinesh Nair, a senior consultant cardiologist at Parkway Heart and Vascular Centre.

The situation in Singapore

Doctors here said they have not observed any obvious spike in deadly heart attacks during any holidays.

Certain reasons used to explain the spike in the West, such as fewer medical professionals on duty during the festive season, may not apply here.

The absence of an obvious spike here could also be because the total number of fatal heart attacks here is too small for any incremental spike in a particular month to be obvious, said Dr Chin Chee Tang, a consultant at the department of cardiology at the National Heart Centre Singapore.

The National Registry of Diseases Office recorded 7,189 heart attacks or acute myocardial infarctions in 2010 and 1,257 deaths from heart attacks that year.

The study in Circulation had found the spike in winter holiday deaths only after analysing about 190,000 death certificates each year over 28 years.

Unlike in the United States, where the winter holidays can last about two weeks, in Singapore, there are multiple festivals, such as Lunar New Year, Hari Raya and Deepavali, for different ethnic groups spread out throughout the year, said Dr Chin.

Each festival lasts only a few days, probably not long enough for any behavioural modifications to impact hospital admissions or even survival rate, he said.

When researchers at the National University Heart Centre Singapore wanted to look at how sociocultural practices affected heart failure admissions, they chose to look at month-long events, such as the Muslim fasting month of Ramadan and the Chinese Hungry Ghost Festival.

The study found the opposite to be true: Fewer Malays and Chinese respectively are admitted to hospital for heart failure. This is possibly because of the greater compliance to dietary and fluid restriction and even medication during the fasting month for Muslims and maybe because the Chinese eat more healthily to avoid the bad luck of landing in hospital during the Hungry Ghost month.

Some lose control on holiday

People’s behaviour during such religious occasions would differ somewhat from their behaviour during festive seasons such as Christmas and New Year, where they are likely to be in a more celebratory mood, said doctors here.

Like their counterparts in the West, they may also delay seeking treatment and overindulge in food and alcohol during festive seasons.

Dr Goh Ping Ping, a cardiologist in private practice and a board member of non-profit Singapore Heart Foundation, said it is not uncommon for people, especially the elderly, to put off treatment for as long as possible during the holiday season. They become more ill as a result.

Patients who are admitted to the hospital before a holiday are impatient to be discharged before they are fully well. This can result in re-admissions with poorer outcomes, she said.

She said it is also common for people’s blood pressure, blood glucose and cholesterol levels to spin out of control at such times, especially when travelling.

This is due to dietary changes, disruptions to regular exercise and sleep patterns, participation in adventurous activities and neglect in taking regular medications.

Dr Goh said: “I have seen patients return from holidays with very high blood pressure, complaining of symptoms such as headache and breathlessness and putting themselves at risk of heart attack and stroke.”

After their near-death experiences, however, Mr Siow and Mr Tan have no intention of losing control in the upcoming festive season.

Both have embarked on healthy diet and exercise regimens. Mr Siow has lost about 3kg and Mr Tan, 6kg.

As Mr Siow put it: “I have learnt my lesson. I don’t want to undergo another surgery again. It was an awful experience.”

Source: Mind Your Body, The Straits Times

Category: Education

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