Abstract 3715: Inflammatory and Thrombotic Changes in Bereavement: A Potential Mechanism of Increased Cardiovascular Risk

Abstract

Background: Bereavement is associated with increased risk of cardiovascular disease (CVD) especially in early bereavement. The mechanism of increased risk has not been well studied. This prospective study evaluated inflammatory and thrombotic measures in bereaved spouses and parents, within 2 weeks of bereavement and again at 6 months. Methods: Fifty-one subjects (35F/17M; aged 65.2 ± 13.1 years (mean ± SD) were prospectively studied within 2 weeks of bereavement and at 6 months, and compared to 43 non-bereaved relatives of discharged patients; age 61.1 ± 11.1 years). All participants had haemostatic measures obtained between 8 –11 am and processed within one hour. White cell subpopulations and activation marker levels were obtained using flow cytometry. Group results were analysed using ANOVA controlling for age. Results: Acute bereavement versus controls: Compared to controls, acutely bereaved had a higher white cell count (WBC) 7.1 vs 6.2 10 9 /L (p<0.001), higher neutrophil count 4.4 vs 3.5 10 9 /L (p=0.001) and a trend towards higher monocyte count 468 vs 525/uL (p=0.06). Acutely bereaved subjects also had a reduced T suppressor cell number (CD8 + ) (406 vs 496 MFI, p=0.02), increased activation marker CD26 on CD4 T cells (541 vs 496 MFI, p =0.02) and increased NK cells positive for CD57 (46.5% vs 39.8%, p=0.05). Acutely bereaved subjects had higher levels of vWF-Ag than controls 126% vs 116% (p=0.04), and higher cortisol levels (340 vs 277 nmol/L (p=0.007). Bereavement - acute versus 6 months: Compared to acute assessment results shown above, the bereaved at 6 months showed reduced WBC count (6.2 10 9 /L; p=0.003), neutrophil count (3.7 10 9 /L; p<0.001), monocyte count (486, p=0.009) and CD57 + NK cells (p <0.001). vWF-Ag was also lower (114%; p=0.02) as was factor VIII-ac (1.33 vs 1.17, p = 0.001). Fibrinogen and C-reactive protein did not change significantly from acute to 6 months. Conclusion: Acute bereavement is associated with increased inflammatory and prothrombotic changes. These findings provide insight into potential mechanisms for the increased CVD risk with bereavement and clues to potential preventive measures.