Sue Leahy remembers one particular Christmas day vividly. At the time, Leahy, now president of the American Safety and Health Institute in New Paltz, N.Y., was a paramedic on call.
"A man had shoveled snow on Christmas Eve and thought he had pulled a muscle, so he let it alone for the night," she recalls. When the pain failed to subside the following morning, he dialed 911. "He actually apologized for disturbing us on the holiday," she says. But he was right to make the call, she says, "he did not pull a muscle; he had suffered a heart attack."
A classic heart attack is marked by pain in the chest that may radiate down the left arm, but sometimes it may feel more like a muscle pull, she explains. The pain usually lasts more than a few minutes and can wax and wane in intensity. "The heart is a muscle, and the pain could be from a clogged artery in the heart," she says, but the pain can radiate, making it appear to be a pulled muscle in the back or neck.
"When in doubt, go to the emergency room or call 911 and get it checked out," she says. Leahy's advice is especially prudent in winter months when research has shown heart attacks are more common and more severe. A report in the Dec. 13, 2004, issue of Circulation: Journal of the American Heart Association found that the rate of heart disease-related deaths (as well as deaths from other causes) rose sharply between Dec. 25 and Jan. 7. In fact, the death rate peaked on Christmas Day and New Year's Day.
Exactly why winter is prime time for heart attack is still an evolving story, but many theories exist and possibly overlap.
During the winter months, "there is a change in the ratio of daylight hours to dark hours, which changes the hormonal balance, and the hormones involved, such as cortisol, can lower the threshold for a cardiovascular event," explains Stephen P. Glasser, MD, a professor of preventive medicine at the University of Alabama at Birmingham School of Medicine, in Birmingham, Ala.
The Plot Thickens
But that's not all that's going on. Cold temperatures cause arteries to tighten, restricting blood flow and reducing the oxygen supply to the heart, all of which can set the stage for a heart attack.
"In cold weather, there is more oxygen demand by the heart because it is working harder to do the work and maintain body heat," Glasser says.
Glasser says studies have shown that heart attacks and complications related to heart disease occur more frequently in the morning hours.
Research suggests that the early-morning rise in blood pressure, or "a.m. surge," that occurs in most people may dramatically increase the risk of having a heart attack or stroke. "In the winter, people tend to exert themselves or do yard work in the morning because it gets dark earlier," he tells WebMD.
"This shift of activities to morning hours adds to the normal circadian variation in mornings --further increasing heart rate, blood pressure, and the hormones that lower the threshold for a cardiovascular event," he says.
Risk Flies South With the Snowbirds
But this increase is not limited to the cold climate. In fact, snowbirds, too, are at an increased risk even when they head to warmer climates to avoid the cold. Increases in winter heart attacks have been documented in warmer climates such as in Florida and Southern California.
"In California, we still have the same spike in heart attacks," says Karol Watson, MD, PhD, co-director of preventive cardiology at the University of Southern California at Los Angeles (UCLA). The reason? Flu season, she says. "We know that inflammation can trigger a heart attack and the flu causes inflammation." In turn, inflammation can make arterial plaque less stable, and they may dislodge, block arteries, and contribute to a heart attack.
But "a flu shot can lower the risk of heart attack," she says. People at high risk for the flu, including people older than 65 and those with heart disease risk factors, should make sure to get the shot.
Knowledge, Moderation Are Key
In terms of preventing a heart attack this winter, "knowledge is the greatest tool," Alabama's Glasser says. "Being aware is important, and if you are at risk for heart disease and have not been exerting yourself in the morning and want to switch to a.m. hours, cut back on the level and duration of the activity," he says.
"Start slow," he cautions. "The cardiovascular system can adapt to slow and progressive changes, but it has a much more difficult time adapting to sudden changes."
ASHI's Leahy agrees. "When you go to shovel snow, do it for just 15 minutes at a clip and then let the body recuperate," she says. "Don't overdo it, especially if you are not used to any exercise."
Before you go out, check your pulse rate, she says. Here's how: "Count it out for 30 seconds, multiply it by two, and go out and shovel," she says. Your pulse will quicken when shoveling. "Go back inside after 15 minutes and then return when your pulse is back to normal."
But "don't go inside and have a cup of coffee or smoke a cigarette when you warm up because caffeine and nicotine just put that much more burden on the heart."
Exercisers, Revelers Are Also at Increased Risk
It's not just shovelers who run the risk of taxing their heart in the winter. Every Jan. 1, millions of people join gyms as part of their New Year's resolution to get in shape -- and many may overexert themselves too soon.
"There is no question that exercise is good, but exercise that the body is not prepared to handle is not good," UCLA's Watson says. "Start an exercise regimen under the supervision of your doctor if you have heart disease risk factors, and even if you don't, start slow." Beginning your new routine gradually is not only less taxing on your body, but it's also is easier to stick to. And talk to your doctor about what your heart disease risk factors are.
It's also important to watch what you eat and drink during the winter months, experts tell WebMD. "People eat more, drink more, smoke more, and gain more weight during the holiday season," Watson says.
And "the other thing is that the holiday period is very stressful in terms of family issues it may bring up and financial pressure, she says. Anxiety and depression tend to peak for some people around the holiday season and are also linked to heart attack and stroke.
The bottom line? "If you know have risk factors for heart disease like high cholesterol and high blood pressure, see your doctor and make sure you are on the right regimen and treatment plan," she says.