As a new study finds that the bereaved are six times more likely to have a heart attack in the week after the death of a loved one, counsellors and medical experts discuss how grief affects health, and whether anything can be done about its negative impact on relatives' broken hearts.
By Lisa Salmon When a member of the family dies, their devastated loved ones may feel they too could die of a broken heart.
Now a new study has found such feelings aren't just romantic nonsense - bereaved people are 21 times more likely to have a heart attack the day after their loss.
Even the week after a 'significant other' dies, close relatives and friends are six times more at risk of a heart attack, the Harvard Medical School study found.
Elizabeth Mostofsky, lead author of the new study on bereavement and heart attacks, explains: "Grief is known to cause feelings of depression, anger and anxiety, and those emotions can cause an increase in heart rate, blood pressure and blood clotting.
"Those factors can in turn increase the chances of having a heart attack."
The bereaved are also more likely to get less sleep, eat poorly, and have higher levels of the stress hormone cortisol, all of which contribute to an increased heart attack risk.
Regular medications can also end up being neglected, warns Mostofsky: "A heart attack is always due to a confluence of risk factors - the perfect storm," she says.
"A person has to be both at risk and have the loss - the body has to be vulnerable to that event."
In fact, the study found that the newly bereaved's heart attack risk was greatly elevated if they already had poor heart health, ranging from about one in 300 to less than one in 1,000, depending on the individual's previous heart health.
The Harvard researchers asked 1,985 people who'd survived a heart attack, with an average age of 61, if they'd recently lost anyone significant in their lives, and how meaningful the loss was. For some people, the death of a 'significant other' meant relatives, for others it was friends or neighbours.
Among the study participants, 270 (13.6%) had lost a significant person in the previous six months, including 19 whose loss was no more than a day before their heart attack.
As bereavement is unavoidable, lowering long-term risk factors is the best way to prevent a heart attack as you grieve, says Mostofsky.
"By improving diet and exercising, you're less likely to have this response to a bereavement," she stresses.
"Cutting down on your baseline risk is always a good idea."
She says the bereaved and their families should be aware of the sharply increased risks during the grieving period, and families should ensure the bereaved person is taking care of themselves.
"Having social support during this intense emotional experience may help mitigate the risk," she explains.
Mostofsky stresses that any possible signs of a heart attack, such as chest discomfort, upper body or stomach pain, shortness of breath, breaking into a cold sweat, nausea or light-headedness shouldn't just be dismissed.
"If a bereaved person is experiencing symptoms of a heart attack, they shouldn't ignore it and put it down to the fact that they're dealing with a stressful experience," she warns.
"They should take it seriously and seek medical attention."
Dr Mike Knapton, the British Heart Foundation's associate medical director, stresses: "Obviously you can't do anything about a bereavement, so the message is to think about your cardiovascular risk now."
This means following the usual messages of not smoking, eating a healthy diet, exercising, and taking any medication needed, he says.
"The key is to make sure your resilience is as good as it can be in the event of a bereavement by looking after your health now."
While there's an established association between anxiety, depression and heart disease, Knapton points out: "It's not that everybody who's bereaved gets depressed, but if you do, it's bad for the heart."
But heart attacks aren't the only serious health problem linked to grieving. A 2007 review of mortality and bereavement research by Dr Margaret Stroebe, of Utrecht University in the Netherlands, found that the risk of death from any cause increases by up to a fifth following bereavement.
The study, published in The Lancet, said that the increased risk of death for widowers could be linked to drinking more alcohol after their partner's death, plus the loss of their sole confidante.
In widows, the possible cause of increased mortality risk was less clear, but intense loneliness and psychological distress may be responsible.
Dr Stroebe's team said: "The mortality of bereavement is attributable in large part to a so-called broken heart - the psychological distress due to the loss."
Debbie Kerslake, chief executive of Cruse Bereavement Care, says all the research highlights the vital need to provide support for bereaved people, as a death can have a significant impact on loved ones' mental and physical health.
Stressing that Cruse can help people cope with grief through face-to-face, telephone and online support, she advises: "It's very hard, but grieving people need to take care of themselves; eating regularly, trying to get rest, taking exercise, not resorting to alcohol or drugs and seeking support from an organisation like Cruse, or their GP, if they're concerned about their health."
She does, however, warn that worrying symptoms can sometimes be caused by anxiety, rather than a serious health problem.
"Although there's an association between bereavement and heart attacks, anxiety - which is natural after a bereavement - can also cause heart palpitations and other physical symptoms," she explains.
"If you're worried, consult your doctor, but not with the assumption that anything's wrong."
:: For support after bereavement, contact Cruse Bereavement Care on 0844 477 9400, or visit www.cruse.org.uk.