Why are there winter heart attack spikes?

Main Category: Hypertension
Article Date: 19 Nov 2004 - 12:00 PDT


According to a new Harris Interactive(R) survey commissioned by Biovail Pharmaceuticals, Inc., a majority of U.S. adults who suffer from high blood pressure (also known as hypertension) (81 percent) engage in behaviors* that could heighten the risk for a heart attack during the winter holidays, the time of year when cardiovascular events are most likely to occur. For example, the poll revealed that between Thanksgiving and New Year's Day, many U.S. adults with hypertension eat more than usual (62 percent), experience heightened stress levels (48 percent), experience weight gain (37 percent), and exercise less or quit exercise altogether (29 percent) - all contributing factors to heart attack risk.(1)

"High blood pressure is a serious health problem that may be an even greater risk during the winter holiday season given the preponderance of unhealthy behaviors, increased stress and the heightened incidence of heart attack," said Karol E. Watson, MD, PhD, Director of the UCLA Center for Cholesterol and Hypertension Management. "What is most concerning is that so many individuals with high blood pressure appear to drop their guard at a time when they should be more mindful of the increased danger."

Winter Mornings May be Particularly Risky

Studies demonstrate that more heart attacks occur nationwide during winter than any other season.(2) Researchers believe that a combination of an increased prevalence of respiratory infections (i.e., flu) in the winter months, increased consumption of fatty foods, salt and alcohol in wintertime (particularly during the winter holidays), emotional and psychological holiday stressors, and imbalances in the body's hormonal levels due to reductions in the amount of sunlight may be contributing factors.(3-5) Likewise, mornings are a particularly dangerous time of day for individuals with high blood pressure. Specifically, the risk of heart attack is 40 percent higher in the morning compared to any other time of day.(6) The poll revealed that a majority of U.S. adults with hypertension (64 percent) are unaware or unsure that the winter months are when they are most at risk for a heart attack, and 66 percent are unaware or unsure that mornings are the riskiest time of day.(1)

"A combination of wintertime factors plus morning blood pressure surges means that winter mornings may be an especially dangerous time for people with high blood pressure and other cardiovascular conditions," said Dr. Watson. "These patients should consult their physicians to discuss treatment options that offer maximum blood pressure control in the early morning hours and help reduce seasonal cardiovascular risks."

The survey results demonstrate that three out of four patients** (75 percent) take their blood pressure medication in the morning.(1) Yet, studies show that nighttime dosing of an extended-release formulation of the blood pressure medication diltiazem, also known as Cardizem(R) LA, which offers 24-hour blood pressure control, was more effective in reducing morning blood pressure peaks than was the same medication dosed in the morning.(7)

Seasonal Stressors

The survey of 1,017 U.S. adults with high blood pressure revealed various other factors and behaviors that may contribute to cardiovascular problems during the winter holidays:(1)

-- Three out of four (75 percent) respondents reported feeling some degree of stress during the winter holidays, and about half (48 percent) reported feeling more stressed compared to the rest of the year. This increase in stress level was more pronounced among women than in men (56 percent vs. 39 percent).

-- The four most commonly cited winter holiday stressors include: winter holiday expenses (42 percent), general financial concerns (39 percent), winter holiday shopping and gift-giving (38 percent), and winter holiday preparations (28 percent).

-- Sixty-four percent admitted that they "significantly/moderately" increase their intake of high-fat and/or high-salt foods during the winter holidays.

-- One in four smokers(+) (25 percent) report smoking more than usual during the winter holidays.

According to the latest government reports, one in three U.S. adults, or 65 million people, have high blood pressure.(8) Of these, only two-thirds know that they have it and only one in three have the condition under control.(9)

In addition, people with a systolic blood pressure of 120-139 mmHg or a diastolic blood pressure of 80-89 mmHg, levels that were previously considered as normal, now have a condition called "prehypertension."(9)

People in this category cover about 22 percent of U.S. adults(10), or about 45 million people, and are encouraged to modify their lifestyles to prevent cardiovascular disease.(9)

Tips for Managing Winter Holiday Heart Risks

To help control blood pressure during the winter holidays, experts advise the following:

-- Know your number. Have your blood pressure checked by your physician at least once each year. If you already have high blood pressure, it should be checked more frequently.(11)

-- Manage high blood pressure to control morning surges. In addition to lifestyle modifications, you may also need medicine to lower your blood pressure. Some medications, such as Cardizem(R) LA, which offers 24-hour blood pressure control, when dosed in the evening,(++) deliver optimal levels of the effective blood pressure agent diltiazem in the morning hours when individuals with high blood pressure are most at risk.(6-7)

-- Reduce rich, fatty foods and winter "holiday spirits." Excess body fat increases the chances of developing high blood pressure, and heavy and regular use of alcohol can increase blood pressure dramatically.(12)

-- Stay active. Make time for exercise. An inactive lifestyle makes it easier to become overweight and increases the chance of high blood pressure. Exercising throughout the winter holidays can help relieve tension and burn off extra calories.(12)

-- Shop ahead and online. Avoid the winter holiday hustle and bustle by shopping earlier than usual. Also, consider purchasing gifts via the Internet to save time and avoid stress in winter holiday traffic and on store lines, which may cause short-term but drastic increases in heart rate and blood pressure. If you worry about winter holiday expenses, create a winter holiday "spending account" early in the year and add money to it each month.

-- Stop and smell the poinsettias. Don't get stressed out about preparations, such as decorations and gift-wrapping. Make time to enjoy celebrations with family and friends and be sure your expectations for the winter holidays are realistic and practical.(12)

-- Schedule downtime. Instead of accepting every party invitation, spend some quiet time alone and with people whose company you really enjoy. The best gift you can give yourself and family or friends is a relaxed, happy, and healthy you.

For more information on high blood pressure and minimizing risk factors, visit: http://www.americanheart.org or http://www.cardisense.com.

Important Safety Information

CARDIZEM LA is indicated for hypertension and chronic stable angina. CARDIZEM LA is contraindicated in patients with sick sinus syndrome or 2nd degree or 3rd degree AV block (except in the presence of a functioning ventricular pacemaker), hypotension (<90 mm Hg systolic), demonstrated hypersensitivity to the drug, and acute myocardial infarction and pulmonary congestion documented by x-ray on admission.

Worsening of congestive heart failure has been reported in patients with preexisting impairment of ventricular function. Caution should be exercised in these patients when diltiazem is used in combination with beta-blockers. In rare instances, elevations in LFT enzymes have been noted.

Concomitant use of diltiazem with beta-blockers or digitalis may result in additive effects on cardiac conduction. Patients taking drugs that are substrates or inhibitors of CYP450 3A4 (ie. cimetidine, midazolam, triazolam, cyclosporine, carbamazepine, lovastatin, simvastatin, rifampin), or patients with renal and/or hepatic impairment, may require dosage adjustment when starting or stopping concomitantly administered diltiazem.

Whether the time of administration impacts the clinical benefits of antihypertensive treatment is not known.

In hypertension, the most common adverse events greater than placebo were lower-limb edema (5%), sinus congestion (1%), and rash (1%).

In chronic stable angina, the most common adverse events (>2% and greater than placebo) were lower-limb edema (6.8%), dizziness (6.4%), bradycardia (3.6%), and 1st degree AV block (3.2%).

About the Survey

The "Holiday Heart Risks" survey examined the behaviors of U.S. adults with hypertension between Thanksgiving and New Year's Day. The online survey was conducted by Harris Interactive(R) and sponsored by Biovail Pharmaceuticals, Inc. between September 14 and 17, 2004, among 1,017 U.S. adults (aged 18 and over) with hypertension, of whom 883 currently take medication of the condition, 214 smoke everyday/occasionally, 616 are male, and 401 are female. The data were weighted to be representative of the total U.S. adult population with hypertension on the basis of age, sex, race, education, region, and household income. Propensity score weighting was also used to adjust for respondents' propensity to be online.

In theory, with probability samples of this size, one could say with 95 percent certainty that the results have a statistical precision of plus or minus 3 percentage points for the overall sample. The statistical precision for the adults with hypertension who currently take medication for the condition sample is plus or minus 3 percentage points, plus or minus 7 points for the adults who smoke everyday/occasionally sample, plus or minus 4 percentage points for males, and plus or minus 5 percentage points for females. This online survey is not a probability sample.

About Harris Interactive(R)

Harris Interactive (http://www.harrisinteractive.com) is a global research firm that blends premier strategic consulting with innovative and efficient methods of investigation, analysis and application. Well known for The Harris Poll(R) and for pioneering Internet-based research methods, Rochester, New York-based Harris Interactive conducts proprietary and public research to help its clients around the world achieve clear, material and enduring results.

Harris Interactive combines its intellectual capital, databases and technology to advance market leadership through its U.S. offices and wholly owned subsidiaries: London-based HI Europe (http://www.hieurope.com), Paris-based Novatris (http://www.novatris.com), Tokyo-based Harris Interactive Japan, recently acquired U.S.-based WirthlinWorldwide (http://www.wirthlinworldwide.com) and through a global network of affiliate firms.

* These behaviors include: drinking more alcohol than usual, eating more than usual, increasing intake of high-fat and/or high-salt foods, gaining weight, exercising less or not exercising at all, smoking more than usual, sometimes/often/always forgetting to take high blood pressure medication, and sometimes/rarely/never following their doctor's recommendation during the holidays

** U.S. adults with hypertension who are currently taking medication for the condition (n=883) (+) U.S. adults with hypertension who smoke everyday/occasionally (n=214) (++) Whether the time of administration impacts the clinical benefits of antihypertensive treatment is not known.

Contact:
Maria Margiotta
201-585-9547
mdmargiotta@prland.com

References:

(1) Holiday Heart Risks. Rochester, NY: Harris Interactive(R); September 2004.

(2) Spencer FA, Goldberg RJ, Becker RC, Gore JM. Seasonal distribution of acute myocardial infarction in the Second National Registry of Myocardial Infarction. J Am Coll Cardiol. 1998;31:1226-1233.

(3) Kloner RA, Poole WK, Perritt RL. When throughout the year is coronary death most likely to occur? A 12-year population-based analysis of over 220,000 cases. Circulation. 1999;100:1630-1634.

(4) Meier CR, Jick SS, Derby LE, Vasilakis C, Jick H. Acute respiratory-tract infections and risk of first-time acute myocardial infarction. The Lancet. 1998;351:1467-1471.

(5) Zipes D. Warning: The short days of winter may be hazardous to your health. Circulation. 1999:100:1590-1592.

(6) Elliott WJ. Cyclic and circadian variations in cardiovascular events. Am J Hypertens. 2001;14:291-295.

(7) Glasser SP, Neutel JM, Gana TJ, Albert KS. Efficacy and safety of a once daily graded-release diltiazem formulation in essential hypertension. Am J Hypertens. 2003;16:51-58.

(8) Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000. Hypertension. 2004;44:1-7.

(9) The Seventh Report on the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Bethesda, Md: National Heart, Lung, and Blood Institute Health Information Center, US Dept of Health and Human Services; 2003. NIH publication 03-5233.

(10) National High Blood Pressure Education Program. The Seventh Report on the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). Available at: http://www.nhlbi.nih.gov/guidelines/hypertension/speaker2.htm. Accessed October 8, 2004.

(11) Medline Plus. Physical exam frequency. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm. Accessed October 9, 2004.

(12) American Heart Association. Risk Factors and Coronary Heart Disease. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4726. Accessed August 18, 2004. Web Sites: http://www.americanheart.org http://www.cardisense.com

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