Cumulative Impact of Stressful Life Events on the Development of Takotsubo Cardiomyopathy
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ORIGINAL ARTICLE
Cumulative Impact of Stressful Life Events on the Development of Takotsubo Cardiomyopathy Lindsey Rosman, PhD 1 & Shira Dunsiger, PhD 2,3 & Elena Salmoirago-Blotcher, MD, PhD 4
# The Society of Behavioral Medicine 2017
Abstract Background The role of stressful life events in the onset of Takotsubo cardiomyopathy (TC) is unclear. Purpose This study sought to examine associations between type, timing, and number of stressful life events and onset of TC. Methods A case-control study conducted among consecutive incident female TC cases and myocardial infarction (MI) controls admitted to two emergency departments in New England. Healthy female controls (HC) were recruited from a volunteers’ registry. Information about the timing, type, and number of triggers during the 6 months preceding hospitalization was systematically collected using the PERI Life Events Scale about 1 month post-discharge. Group differences were evaluated using ANOVA, chi-square, and KruskalWallis statistics. Generalized linear models were used to adjust for confounding variables. Results Between March 2013 and October 2015, 107 women were enrolled (45 TC, 32 MI, and 30 HC). Specific stressful events (death of a relative or close friend (p = 0.006); illness or injury to a relative or close friend (p = 0.001) were more prevalent in TC cases than MI and HC controls. The onset
* Lindsey Rosman [email protected]
1
Department of Medicine, Yale School of Medicine, New Haven, CT, USA
2
Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
3
Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
4
Department of Medicine, Brown University Medical School and The Miriam Hospital, Providence, RI, USA
of TC was associated with exposure to multiple stressful life events during the 6 months preceding the index hospitalization (p < 0.001) but not with exposure to an acute, recent event (p = 0.96). Conclusions TC onset was associated with specific life events (death or illness to close relative or friend) and with the number of stressful life events occurring in the 6 months preceding hospitalization. These findings suggest that grief and cumulative stress could play a major role in the onset of TC. Keywords Cardiomyopathy . Stress . Heart failure . Women’s health
Introduction Takotsubo cardiomyopathy (TC) is a syndrome primarily diagnosed in post-menopausal women characterized by transient left ventricular dysfunction and electrocardiographic abnormalities in the absence of significant coronary artery disease [1, 2]. Although the literature consistently reports that TC is often associated with an acute, emotionally intense event, up to one-third of TC cases have no identifiable precipitant [3], and the prevalence of documented emotional triggers varies considerably across studies (27.0 to 70.0%) [1, 4–6]. Moreover, methodologic differences in research design, timing of assessment, and the use of retrospectively collected data may contribute
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