CV events spiked after 2016 presidential election, perhaps due to sociopolitical stress
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Acute CVD events in a Southern California cohort were 1.62 times higher in the 2 days after the 2016 U.S. presidential election compared with the same 2 days the week before the election, researchers reported.
The findings, published in the Proceedings of the National Academy of Sciences of the United States of America, were consistent across demographic categories and the researchers attributed the spike to sociopolitical stress.
Mefford MT, et al. Proc Natl Acad Sci U S A. 2020;doi:10.1073/pnas.2012096117.
“This is a wake-up call for every health professional that we need to pay greater attention to the ways in which stress linked to political campaigns, rhetoric and election outcomes can directly harm health,” David Williams, PhD, MPH, Florence Sprague Norman and Laura Smart Norman Professor of Public Health at the Harvard T.H. Chan School of Public Health, said in a press release.
The researchers analyzed approximately 3 million members of the Kaiser Permanente Southern California health system who were aged at least 18 years at the time of the 2016 presidential election (64% aged 18-54 years; 53% women; 41% Hispanic).
In the 2 days after the presidential election, the rate of CVD hospitalizations was 573.14 per 100,000 person-years vs. 353.75 per 100,000 person-years for the same 2 days the week before the election (RR = 1.62; 95% CI, 1.17-2.25), according to the researchers.
The effect was slightly higher in women (RR for men = 1.33; RR for women = 2.21; P for interaction = .15) and did not vary by race/ethnicity (P for interaction = .6).
The results did not change when events were compared with those for the same 2 days in the prior 2 weeks, Williams and colleagues wrote.
In the 2 days after the election, there were also higher rates of acute MI (RR = 1.67; 95% CI, 1-2.76) and stroke (RR = 1.59; 95% CI, 1.03-2.44) compared with the same 2 days the week before, according to the researchers, who noted there was no difference in rates between the periods for hospitalizations for chest pain or unstable angina.
“In our diverse patient population that is reflective of Southern California as a whole, we saw that the risk of heart attacks increased after the 2016 election irrespective of sex, age and racial/ethnic groups,” Matthew T. Mefford, PhD, CVD epidemiologist and postdoctoral research fellow at the Kaiser Permanente Southern California Department of Research & Evaluation, said in the release. “It is important that people are aware that stress can trigger changes in their health, and that health care providers help patients cope with stress by encouraging wellness strategies such as exercise, yoga, meditation and deep breathing.”
Perspective
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Hitinder S. Gurm, MBBS
There was a substantial increase in CV events 2 days after the election of 2016 in this large cohort. The authors evaluated the association using multiple elegant analyses and the findings were uniformly consistent.
I agree with the authors that sociopolitical stress is the most likely factor that explains the findings. It is hard to think of another explanation that can explain this association.
The most important intervention from a patient perspective is to have a heart-healthy lifestyle. It is important to avoid all exposure to tobacco (both first and secondhand), ensure that BP is well controlled, ensure that cholesterol is under control, get enough exercise and maintain a healthy body weight. Whether learning stress management coping strategies can reduce this risk is a big unknown factor, but it may be worth considering for some patients.
We are currently in the midst of a global pandemic; there is significant economic uncertainty and there have been substantial job losses. The upcoming election in the currently charged political environment and the above-mentioned stressors will probably result in a similar (if not larger) increase in CVD. For the general public, among other things, this would be the time to ensure that they give up smoking if they smoke and get their cholesterol and BP checked.
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