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    Spring May Mean More Than Love for Your Heart

    While you are more likely to have a heart attack or an episode of life-threatening arrhythmia during the winter, spring poses some heart risks of its own. New research shows that heart attacks occurring during the spring months are the most likely to cause more extensive damage to the heart muscle itself.

    Seasonal variation is a new method of determining the amount of cell death that occurs in heart attack patients, researchers believe. Summer offered the best statistics, with heart attacks causing 15 to 22 percent less damage than those occurring during other seasons.

    Robert Kloner, M.D., Ph.D and his colleagues at the Heart Institute at Good Samaritan Hospital in Los Angeles studied the results of two large clinical trials, the MILIS study (primarily non-reperfusion) and the TIMI-4 (a thrombolytic study), each measuring how much of the heart muscle died during a heart attack. They presented the results of this study on March 12 at the 49th Annual Scientific Session of the American College of Cardiology being held in Anaheim, California.

    "To the best of our knowledge, this is the first study to show that the size of a heart attack varies by season and is smallest in the summer," said Dr. Kloner.

    When questioned on how summer could provide such benefits, Dr. Kloner said the reasons were unknown, but he offered some possible explanations:
    Heat dilates blood vessels, which would lessen resistance within the vessels and decrease the work-load on the heart.
    Dilated blood vessels mean blood flows more easily and more oxygen can reach the heart.
    Clotting factors, such as fibrinogen, platelets, and blood viscosity are increased in cold temperatures. Heat may allow the opposite effect.
    General stress level is lower in summer, perhaps due to holiday or vacation.
    A holiday from working may mean less emotional and physical stress.
    Less stress means lower levels of adrenaline in the blood and decreased sympathetic nervous activity (which translates to less stress on the cells of the heart).

    Whatever the cause, Dr. Kloner stresses that physicians should be aware that spring brings more serious heart attacks and suggests that they might want to take a more aggressive approach in treating those with signs and symptoms of a cardiac problem during this season.
    .
    What can you do to lower the risks that spring may hazard? By now, Dr. Kloner's suggestions should be familiar. He recommends you lower your intake of fat and cholesterol, stop smoking, control your weight, and increase your level of physical activity. In addition, if you have either hypertension (high blood pressure) or diabetes, then working with your healthcare provider to maintain control of these conditions helps you avoid cardiac complications in any season.

    Editorial comment: We know that a heart attack occurs when a blood vessel plaque acutely ruptures and blocks an artery. Why a specific plaque at a particular moment ruptures remains an important unanswered question. The trigger for a heart attack has been studied extensively. There is clearly a variation during the day - most heart attacks occur in the early morning hours (between 5-9a.m.). This has been attributed to diurnal variations in hormones such as epinephrine and norepinephrine, which increase platelet clotting and thereby block arteries. Emotional stresses also induce heart attacks by increasing the oxygen demands of the heart.

    It is not surprising that the frequency of heart attacks also vary with seasons. Cold temperatures may trigger vasospasm in some people, and snow shoveling is a heavy exertion that may also trigger a heart attack. Spring may bring on heart attacks for a variety of reasons as outlined here. One additional reason is that people are often sedentary in the winter and with spring try to do more activity. This has its risks if done without consulting a physician and ignoring the onset of chest pain. Further analysis of such seasonal data for a variety of biochemical and patients parameters is required.


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