12 February 2020

Can you save a broken heart with common meds?

Cardio Mental Health Patients

Common medications could protect people from the harmful effects of a broken heart, according to Australian research.

Cardiologist Professor Geoffrey Tofler, at the University of Sydney, has long been interested in the role that acute events play in triggering heart attacks. Previous work by his team revealed that the loss of a loved one significantly increased the risk of a cardia event.

“In our Boston study, we found that the risk of heart attack peaked in the first week – about eight-fold over baseline,” Professor Tofler told The Medical Republic. “From one week to one month there was still a four-fold increase over baseline.”

Professor Tofler and his colleagues wanted to see if there was a way to reduce the harmful health effects of bereavement, without interfering with the grieving process itself.

They recruited 85 people who had lost either a spouse or a child in the previous two weeks. These participants were randomly assigned either to a group that took low daily doses of the beta blocker metoprolol (25mg morning) and aspirin (100mg morning) for six weeks, or a group that took a placebo.

The team then monitored the participants’ cardiovascular health and grief reactions over the study period.

They found that participants taking the heart medications had lower levels of home systolic pressure, 24-hour average heart rate, anxiety and depression symptoms.

They were surprised to find that lower levels of anxiety were still seen six months later, long after the participants had stopped taking the medication.

The treatment group also had signs of lower blood clotting, as measured with a platelet response to arachidonic acid.

There was no difference between groups in bereavement intensity, adverse events, or NN intervals index (SDNNi), von Willebrand Factor antigen and platelet-granulocyte aggregates.

Several factors were probably responsible for the link between bereavement and heart attack, Professor Tofler said. Intense grief was often accompanied by other intense feelings, such as anxiety, anger, depression, sadness and guilt.

These emotional changes had an effect on the brain and the body, increasing the heart rate, blood rate, elevating levels of adrenaline and cortisol and putting pressure on blood vessel walls and the heart muscle itself, he said.

For this reason, it was important that a bereaved person was taking care of their heart health, continuing to take their medication and not dismiss symptoms as part of the grief reaction, he said.

Because beta blockers and aspirin were common medications, GPs were familiar with the effects and side effects, and were able to assess whether offering these medications would be appropriate for the patient, Professor Tofler said.

“I actually think there are some implications for other types of bereavement and loss,” he said.

“Here we talked about bereavement due to the loss of loved one, but I think there are other situations – job loss, divorce – where perhaps similar physiological mental health changes are happening where this could be considered.”

American Heart Journal: https://doi.org/10.1016/j.ahj.2019.11.003

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