About 1 in 4 women may develop irregular heart rhythms after menopause, with the main factors being stressful life events and lack of sleep, according to a new study published in the Journal of the American Heart Association .
Research Highlights:
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After menopause, an estimated 1 in 4 women may develop irregular heart rhythms (known as atrial fibrillation) during their lifetime, with stressful life events and insomnia being the main contributing factors, according to new research published today in the Journal of the American Heart Association , an open access, peer-reviewed journal.
Atrial fibrillation can lead to blood clots, strokes, heart failure, or other cardiovascular complications. It primarily affects older adults, and more than 12 million people in the U.S. are expected to develop atrial fibrillation by 2030, according to the American Heart Association.
"In my general cardiology practice, I see many postmenopausal women in perfect physical health who struggle with lack of sleep and negative psychological and emotional feelings or experiences, which we now know can put them at risk for developing atrial fibrillation," said Dr. lead author of the study, Susan. X. Zhao, MD, cardiologist at Santa Clara Valley Medical Center in San Jose, California. "I firmly believe that, in addition to age, genetics and other risk factors related to heart health, psychosocial factors are the missing piece in the puzzle of the genesis of atrial fibrillation."
The researchers reviewed data from more than 83,000 questionnaires completed by women aged 50 to 79 from the Women’s Health Initiative , a major US study. Participants were asked a series of questions in key categories: stressful life events, their sense of optimism, social support and insomnia. Questions about stressful life events addressed topics such as the loss of a loved one; disease; divorce; financial pressure; and domestic, verbal, physical or sexual abuse.
Questions about sleep habits focused on whether participants had trouble falling asleep, whether they woke up several times during the night, and overall sleep quality, for example. Questions about participants’ perspective on life and social supports addressed having friends to talk to during and about difficult or stressful situations; a sense of optimism, like believing that good things are on the horizon; and have help with daily tasks.
Over about a decade of follow-up, the study found:
- About 25% or 23,954 women developed atrial fibrillation.
- For each additional point on the insomnia scale, there is a 4% greater chance of developing atrial fibrillation. Similarly, for every additional point on the stressful life events scale, there is a 2% greater chance of experiencing atrial fibrillation.
"The connection between the heart and the brain has been established for a long time under many conditions," Zhao said. “Atrial fibrillation is a disease of the electrical conduction system and is prone to hormonal changes derived from stress and lack of sleep. “These common pathways likely underlie the association between stress and insomnia with atrial fibrillation.”
Researchers noted that stressful life events, lack of sleep, and feelings such as depression, anxiety, or feeling overwhelmed by one’s circumstances are often interrelated. It is difficult to know whether these factors gradually accumulate over years to increase the risk of atrial fibrillation as women age.
Chronic stress has not been consistently associated with atrial fibrillation, and the researchers note that a limitation of their study is that it was based on patient questionnaires used at the start of the study. However, stressful life events, although significant and traumatic, may not be long-lasting, Zhao notes. Further research is needed to confirm these associations and evaluate whether personalized interventions to relieve stress can modify the risk of atrial fibrillation.
Study details and background:
Participants were recruited between 1994 and 1998.
The average age of the 83,736 women included in the study was approximately 64 years. About 88% of the group were women who identified as white; 7.2% identified as black women; and 2.9% self-identified as Hispanic women.
As women live longer, they may face increased risk and worse outcomes associated with atrial fibrillation. While high blood pressure, obesity, type 2 diabetes and heart failure are recognized risk factors, more research is needed into how exposure to psychosocial stress and general emotional well-being over time may affect potential development. of atrial fibrillation.
Conclusions Our findings add to the growing body of evidence showing a close association between AF and the spectrum of psychosocial risk factors grouped into the stress group and the strain group, highlighting the important role of health-related risk factors. mental in the pathophysiology of AF and strategies to combat it. risk modification. Further studies are warranted to clarify the relationship and mitigate the risks of chronic exposure to psychosocial stressors and AF. |
Clinical perspective
What’s new?
Emerging studies show that psychosocial factors can potentially affect atrial fibrillation (AF) through various mechanisms, although data are limited to a few individual stressors and information in older women remains limited.
In this study, we used hierarchical cluster analysis to analyze the association between a panel of 8 psychosocial stressors and the incidence of AF in 83,736 postmenopausal women in the Women’s Health Initiative studies .
Two distinct groups, the stress group (including stressful life events, depressive symptoms, and insomnia) and the strain group (including optimism, social support, social tension, cynical hostility, and emotional expressiveness), were found to be significantly associated with incidence of AF after adjusting for traditional risk factors.
What are the clinical implications?
Established AF risk factors, such as older age and atherometabolic diseases, do not fully explain AF risk, and it is important to explore new determinants of AF in older women, because they generally live longer and are more likely to develop adverse outcomes. as a result of AF. .
The grouping of psychosocial stressors into stress and strain groups in this study presents a comprehensive assessment of heart-brain interactions in the development of AF in postmenopausal women.
Further prospective research is needed to confirm these associations and evaluate whether personalized stress-relieving interventions based on each individual’s stress/strain group profile can modify AF risk.
