12 Tips to Safeguard Your Heart

The holiday season -- those sometimes intense weeks that begin around Thanksgiving and stretch to New Year's Day and beyond -- can be a time of good cheer, brightly lit parties brimming with food and drink, the pleasure of family reunions, and feelings of generosity and peace. It can also be a lonely time or a stressful one, a season of eating, drinking or spending too much. These downsides, along with other factors, contribute to the spike in heart disease deaths during the holidays.

Striking a balance between celebration and health can be a challenge for anyone. Heart disease complicates matters a bit. With some advance planning and common sense, you and your heart can come out the other side of the holidays no worse for wear and maybe even better.

What Is It About Winter?
A handful of small studies have hinted that death has its season, and that the season is winter. Researchers in San Diego, Calif., and Boston, Mass., took this work a giant step further, thanks to a national database with detailed information on the 53 million deaths that occurred in the United States between 1973 and 2001. The researchers tallied up how many people died on each day of these years, from Jan. 1 to Dec. 31, and graphed the results. Deaths from heart disease gradually climbed from July to January, with a sharp spike between Christmas and New Year's Day, then fell again. This pattern wasn't limited to heart disease deaths; it also occurred with noncardiovascular deaths and all deaths overall.What is it about the holiday season that isn't conducive to good health, or at least to continued life? Researchers have floated a number of possibilities:

• Temperature. Cold temperatures can increase blood pressure and make blood more likely to form artery-blocking clots. Yet the winter increase in heart attacks and heart-related deaths has been seen even in southern California, where what passes for winter would seem balmy to Buffalo, N.Y., residents.
• Short days, long nights. Dwindling daylight alters levels of hormones such as cortisol, melatonin and vasopressin, each of which can affect the heart and mood.
• Cholesterol cycles. In the Northern Hemisphere, levels of total and LDL (bad) cholesterol and triglycerides peak in December and January and are at their lowest around July. Cardiac risk factors such as fibrinogen and plasma viscosity (blood thickness) also rise in winter.
• Respiratory disease. Coughs, colds and the flu are more common during winter than summer. These can cause extra trouble for people with heart failure and other forms of heart disease.
• Holiday stress. Walk through a Toys R Us the weekend before Christmas and you can feel the stress of the season. Traveling to family get-togethers, buying gifts and preparing to host a holiday party can be as stressful for some people as they are enjoyable for others. Stress can fire up chest pain (angina) and trigger heart attacks.
• Changes in diet and alcohol intake. Food and drink are the centerpieces of many holiday gatherings, one reason why so many people gain weight between Thanksgiving and New Year's Day. Although adding a few pounds isn't immediately hazardous, it can certainly tilt you in the wrong direction. Salty snacks and foods are a common reason for heart failure flare-ups during the holidays. Eating too much or too fast can generate heartburn, which can feel like a heart attack and sends many people to the emergency room each season. At the same time, many people delay going to the hospital with chest pain because they think it's heartburn. Alcohol is a double-edged sword; over the long run, a drink a day can reduce cardiac risk, but binge drinking can lead to high blood pressure and abnormal heart rhythms.
• Medication lapses. The hustle and bustle of the holiday season can throw medication schedules out of whack. Missing a dose or two of most medications isn't a big deal; taking an extended medication holiday can be trouble, especially for people with diabetes, heart rhythm problems or heart failure.
• Is there a doctor in the house? Emergency rooms and hospitals don't close for the holidays, even though doctors, nurses, technicians, administrators and just about everyone else who works there jockey for time off. It is possible that the quality of care suffers with overworked or pinch-hitting doctors and nurses, though a study in the Oct. 3, 2005, Annals of Internal Medicine [journal] pours some cold water on this idea. It showed that heart attack deaths were higher in December and January, even though the same evidence-based therapies were used all year.
• Delay in seeking medical care. No one wants to "ruin" Christmas or New Year's Day with a trip to an urgent care center or emergency room. Yet if you procrastinate in seeking care for chest pain or other warning signs of a heart attack, stroke or worsening heart failure, you could get to the hospital after your heart or brain has suffered damage that could have been prevented with earlier attention.
• Travel. In the study looking at deaths between 1973 and 2001, there were only two years without a Christmas/New Year's increase in heart disease deaths: 1973, the year of the OPEC oil embargo, and 1981, a recession year. Travel during these two holiday seasons was dramatically curtailed, which may have reduced stress, improved medication taking, or prevented some delays in seeking medical attention.

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