The weather is getting colder. The days are shorter. People
leave for work in the dark and come home in the dark. Winter is here and with it comes an increase
in heart disease and heart related deaths.
There are many reasons why winter weather worsens heart problems. Heart
patients are under more stress at the extremes of temperatures. Cold weather increases
the workload on the heart. For example,
it is harder to walk in 20 degrees with a biting wind than on a calm 70-degree
day. The cold may cause the heart
arteries to spasm, reducing the blood flow to the heart resulting in chest pain
or a heart attack. Wintertime brings an increase in flu and pneumonia. These
respiratory infections put a significant strain on the heart and are the reason
why the flu vaccine is recommended for all heart patients. Another factor may be the colorfully named
winter blues, or Seasonal Affective Disorder.
Seasonal affective disorder (SAD) is a type of depression
triggered by the shorter days in winter. The depression eases during the summer
months. It is felt that shorter amounts
of sunlight cause a chemical change in the brain. Melatonin, a hormone which is
made when it is dark to aid in sleep, may also be involved. In the winter,
people continue to make melatonin later in the day, as dawn comes later. The melatonin can cause daytime sleepiness
and fatigue. In addition to a sleepy
feeling and fatigue, SAD causes loss of interest in activities formerly
enjoyed, social withdrawal, irritability, anxiety, decreased ability to focus
and physical problems such as chest pain. SAD is different from major
depression in that it causes people to eat more and gain weight. Patients with
major depression have difficulty sleeping, a decreased appetite and weight
loss. SAD is treated with light therapy,
either getting more sunlight or sitting in front of a light box. Psychotherapy and antidepressants are also
used. In addition, patients with SAD should
make an effort to be more social, exercise regularly, and avoid alcohol as it
can make depression worse.
The relationship between depression and heart disease has
mostly been studied in patients with major depression, but it likely applies to
SAD patients as well. It has long been known that depression can lead to heart
disease. Depression can decrease immunity and promote inflammation, conditions
that can lead to plaque formation in heart arteries. In addition, depression
increases certain hormones (catecholamines) which raise the blood pressure and
heart rate, leading to heart disease. Lastly, depression is associated with
poor lifestyle behaviors such as being sedentary, eating the wrong foods,
smoking or alcohol use and not taking prescribed medications. On the other hand, patients with heart disease
are prone to develop depression. After a
heart attack, patients who become depressed are three times more likely to die
than patients who do not have depression. After open-heart surgery depression is quite
common and is associated with worse outcomes.
The winter blues can manifest not only psychologically, but
also physically. The other winter blue
happens when extremities turn blue in cold weather. This is called Raynaud’s Phenomenon. Raynaud’s typically affects the fingers, toes
and the tips of the nose and ears. It
occurs when a trigger (cold or emotional stress) causes extreme spasm of the
blood vessels to the extremity. The
blood flow is cut off causing the affected part to first turn white, then
blue. Often there is pain associated
with the color changes. After about 15 to 20 minutes, the spasm subsides, the
extremity turns bright red and there is a burning sensation as the blood flow
returns. Raynaud’s has two forms, a
primary one where the cause is unknown and a secondary form which is due to
another disease (for example lupus or scleroderma). The primary form occurs in
about 4% of the population, is seen more with women than men and usually starts
at a young age (15-30 years old). The
main treatment is avoidance of the cold and warming. Local warming is with gloves or thick socks;
systemic warming involves keeping the whole body warm with layers of clothing.
In extreme cases, medications can be prescribed, such as calcium channel
blockers or vasodilators.
Whether your winter blues are physical or emotional, one
should make an effort to follow lifestyle behaviors that can help either
condition. This includes regular exercise, as exercise is known to reduce
depression. In addition, exercise causes
the small arteries in the hands and feet to dilate, increasing the blood flow
to those areas. Smoking should be avoided as it worsens depression and causes
the small arteries to spasm. Staying warm by snuggling under a blanket in front
of a roaring fire is not a bad option for either of the winter blues.
