Beta-blocker, aspirin combo mitigates CVD brought on by grief

A beta-blocker and aspirin combination may help attenuate the heightened CVD risk observed in people who have recently lost a loved one, according to research published in the American Heart Journal in February.

Grief has long been linked to an increased risk of cardiovascular disease and complications, first author Geoffrey H. Tofler, MD, and colleagues at Royal North Shore Hospital in New South Wales, Australia, wrote in their paper—in some cases escalating to the point of Takotsubo cardiomyopathy, or “broken-heart syndrome.” Grieving individuals often move through a sequence of depression, anxiety and anger, all of which can put considerable stress on a person’s heart.

“While most people adjust to the loss, there is a heightened risk of mortality up to six months, with cardiovascular disease accounting for up to half of the excess deaths during spousal bereavement,” Tofler and co-authors wrote. “In the Determinants of Myocardial Infarction Onset Study, the relative risk of non-fatal infarction peaked in the first day following bereavement and remained four-fold increased between seven days to one month following bereavement.”

Scientists believe the increased CV risk observed during bereavement may be driven by a hike in systolic blood pressure and heart rate, reduced HR variability, prothrombotic and immune changes and intense emotions, but there’s a paucity of research on the subject. Still, Tofler et al. said some studies have suggested that beta-blockers and aspirin might mitigate some of the cardiovascular stress.

The team studied 85 recently bereaved individuals in a randomized, double-blind, placebo-controlled trial in Australia. Seventy-three spouses and 12 parents of deceased individuals from five hospitals in Sydney were included in the analysis.

Tofler and colleagues assessed each patient within two weeks of their loss before randomizing them to six weeks of either 25 mg of metoprolol plus 100 mg of aspirin daily or a placebo treatment. Heart rate and blood pressure were measured regularly, and the researchers tracked psychological symptoms via regular questionnaires, including the Spielberg State-trait Anxiety and Anger questionnaires, Centre for Epidemiological Studies-Depression (CES-D) Scale and Core Bereavement Items Questionnaire, CBI-17.

Six weeks into treatment, people taking the metoprolol and aspirin combo saw decreased systolic blood pressure (from 135 mmHg to 129 mmHg, on average) and heart rate (from 75 BPM to 67 BPM, on average). In comparison, control patients’ systolic BP remained similar at the six-week mark (a 1 mmHg difference), as did their heart rate (73 BPM at both time points).

Anxiety and depression symptoms seemed to wane in the treatment group, as well—anxiety and depression scores had both fallen after six weeks of treatment, as had measures of anger and bereavement intensity. Numbers continued to decrease through six months.

“The reduced anxiety we found with the active treatment is consistent with limited studies that support beta-blocker use for acute anxiety and panic attacks,” the authors wrote. “The reduction in depressive symptoms was reassuring for the safety of the strategy.

“While clinicians need to be wary of appearing to medicalize an almost universal stressful experience, reducing heart attacks among bereaved people is a worthy goal. At a time when the deceased is the focus of attention, our findings remind clinicians to consider the wellbeing of bereaved individuals more broadly, including encouraging adequate diet and sleep, ensuring medication adherence and reminding the bereaved to seek help for symptoms that may be cardiac.”