Researchers have suggested that one in every four women might develop irregular heart rhythms – known at atrial fibrillation (AF) – after menopause, with stressful life events and poor sleep being major factors in contributing to this, according to their study in the Journal of the American Heart Association.
Atrial fibrillation can lead to blood clots, stroke, heart failure or other cardiovascular complications, and primarily affects older adults.
“In my general cardiology practice, 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,” said lead study author Dr Susan Zhao, a cardiologist at Santa Clara Valley Medical Centre in California.
“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.”
Researchers reviewed data from more than 83 000 questionnaires by women aged 50-79 from the Women’s Health Initiative, a major US study.
Participants were asked a series of questions in key categories: stressful life events, their sense of optimism, social support and insomnia. Questions about stressful life events tackled topics like loss of a loved one, illness, divorce, financial pressure and domestic, verbal, physical or sexual abuse.
Questions about sleeping habits focused on if participants had trouble falling asleep, wake up several times during the night and overall sleep quality, for example.
They were also questioned on their outlook on life and social supports, having friends to talk to during and about difficult or stressful situations; a sense of optimism such as believing good things are on the horizon; and having help with daily chores.
During a decade of follow-up, the study found:
• About 25% or 23 954 women developed atrial fibrillation.
• A two-cluster system (the stress cluster and the strain cluster).
• For each additional point on the insomnia scale, there is a 4% higher likelihood of developing atrial fibrillation. Similarly, for each additional point on the stressful life event scale, there is a 2% higher likelihood of having atrial fibrillation.
“The heart and brain connection has been long established in many conditions,” Zhao said. “Atrial fibrillation is a disease of the electrical conduction system and is prone to hormonal changes stemming from stress and poor sleep. These common pathways probably underpin the association between stress and insomnia with atrial fibrillation.”
Researchers noted that stressful life events, poor sleep and feelings, such as depression, anxiety or feeling overwhelmed by one’s circumstances, are often interrelated. It’s difficult to know whether these factors accumulate gradually over the years to increase the risk of atrial fibrillation as women age.
Chronic stress has not been consistently associated with atrial fibrillation, and the researchers said a limitation of their study was that it relied on patient questionnaires at the start of the study.
Stressful life events, however, though significant and traumatic, may not be long lasting, Zhao notes. Further research is needed to confirm these associations and evaluate whether customised stress-relieving interventions may modify atrial fibrillation risk.
Study details
Association Between Insomnia, Stress Events, and Other Psychosocial Factors and Incident Atrial Fibrillation in Postmenopausal Women: Insights From the Women's Health Initiative
Susan Zhao, Hilary Tindle, Joseph Larson, Nancy Woods, Michael Crawford, Valerie Hoover, Elena Salmoirago‐Blotcher, Aladdin Shadyab, Marcia Stefanick and Marco Perez.
Published in Journal of the American Heart Association on 30 August 2023
Abstract
Background
The association between psychosocial factors and atrial fibrillation (AF) is poorly understood.
Methods and Results
Postmenopausal women from the Women's Health Initiative were retrospectively analysed to identify incident AF in relation to a panel of validated psychosocial exposure variables, as assessed by multivariable Cox proportional hazard regression and hierarchical cluster analysis. Among the 83 736 women included, the average age was 63.9±7.0 years. Over an average of 10.5±6.2 years follow‐up, there were 23 954 cases of incident AF. Hierarchical cluster analysis generated 2 clusters of highly correlated psychosocial variables: the Stress Cluster included stressful life events, depressive symptoms, and insomnia, and the Strain Cluster included optimism, social support, social strain, cynical hostility, and emotional expressiveness. Incident AF was associated with higher values in the Stress Cluster (hazard ratio [HR], 1.07 per unit cluster score [95% CI, 1.05–1.09]) and the Strain Cluster (HR, 1.03 per unit cluster score [95% CI, 1.00–1.05]). Of the 8 individual psychosocial predictors that were tested, insomnia (HR, 1.04 [95% CI, 1.03–1.06]) and stressful life events (HR, 1.02 [95% CI, 1.01–1.04]) were most strongly associated with increased incidence of AF in Cox regression analysis after multivariate adjustment. Subgroup analyses showed that the Strain Cluster was more strongly associated with incident AF in those with lower traditional AF risks (P for interaction=0.02) as determined by the cohorts for heart and aging research in genomic epidemiology for atrial fibrillation score.
Conclusions
Among postmenopausal women, two clusters of psychosocial stressors were found to be significantly associated with incident AF. Further research is needed to validate these associations.
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