Cardiovascular disease (CVD) is the leading cause of death for women in New Zealand and globally. The risk of developing CVD increases with age, particularly once women have reached menopause.
Now, new research has found that up to one in four women develop an irregular heartbeat after menopause – and it seems that insomnia and stress are contributing factors.
The study, which was published in the Journal of the American Heart Association, analysed data of more than 83,000 women, aged 50 to 79, who participated in the Women's Health Initiative, a major long-term health study in the US.
The questionnaires looked at participants’ medical history, health habits, stressful life events (including divorce, abuse and loss) and sleeping habits.
Over a decade follow-up period, the study found that about 25 per cent, or 23,954 women, developed atrial fibrillation (AF) – an irregular and often very rapid heartbeat. Those who had higher ratings of stressful life events, insomnia and depressive symptoms had a higher risk of atrial fibrillation.
“I see many postmenopausal women with picture-perfect physical health who struggle with poor sleep and negative psychological emotional feelings or experience, which we now know may put them at risk for developing atrial fibrillation,” lead author Dr Susan Zhao, a cardiologist at Santa Clara Medical Centre in San Jose in the US, said in a news release.
“I strongly believe that in addition to age, genetic and other heart-health related risk factors, psychosocial factors are the missing piece to the puzzle of the genesis of atrial fibrillation.”
While AF itself may not be dangerous, it is important to diagnose and treat it because it increases the risk of other conditions, such as heart failure and stroke.
“Atrial fibrillation is a disease of the electrical conduction system and is prone to hormonal changes stemming from stress and poor sleep,” Dr Zhao said. “These common pathways likely underpin the association between stress and insomnia with atrial fibrillation.”
While high blood pressure, obesity, Type 2 diabetes and heart failure are recognised risk factors of AF, the authors believe more research is needed to determine why stress and other aspects of well-being may also affect its potential development.
Symptoms of atrial fibrillation
AF may not cause any symptoms, or the symptoms may only occur some of the time. It is also possible for AF to go undetected for long periods of time, which is why screening is so important.
Common symptoms of AF include:
- heart palpitations
- racing or ‘fluttering’ heartbeat
- irregular heartbeat, which can be detected by checking the pulse
- pain or discomfort in the chest (angina)
- breathlessness, especially during activity
- dizziness and light-headedness
- tiredness and weakness.
How to decrease your risk of atrial fibrillation
There is a strong association between AF and high blood pressure, a sedentary lifestyle and obesity.
In order to help prevent and manage AF, some simple lifestyle changes could help:
- Control high blood pressure through medication or dietary changes
- Exercise regularly, such as by setting up your own exercise program
- Reduce alcohol consumption
- Manage diabetes through diet or medication
- Quit smoking
Living with atrial fibrillation
The irregular occurrence of AF episodes can be stressful and overwhelming.
However, there are several strategies you can put in place to help manage your AF and continue to live a full and active life.
- Keep a record of your symptoms. Note down whenever you experience an AF episode and how long it lasts, as well as any other symptoms. Bring this record to your next doctor’s appointment.
- Check your pulse regularly and keep a log. Take your own pulse regularly, and keep a record to show your doctor. This will help highlight if there are any changes in your heartbeat to keep an eye on.
- Learn your triggers. Episodes of AF can be triggered by certain foods, exercises, stimulants or even stress in some people. Writing down the context each time you experience AF can help you to identify whether you have a trigger and to avoid it in the future.
- Follow your doctor’s advice. Your doctor may advise lifestyle and dietary adjustments, and provide strict guidelines around any prescribed medications. Follow these carefully for the best health outcomes.
How is HRI fighting atrial fibrillation?
HRI is tackling the widespread problem of AF from a broad range of research angles. The mission of our Heart Rhythm and Stroke Prevention Group is to prevent as many strokes as possible through early detection of silent AF, and to implement appropriate guideline-based management. With a clinical implementation focus, the Group is exploring novel strategies using eHealth tools and patient self-screening to detect unknown silent AF.
If screening for AF could be implemented more widely in people aged 65 and older, along with preventative treatments being prescribed as advised in guidelines, then thousands of strokes could be avoided globally, making a difference to patients and their families.