Figure 4 vWF-ag levels

and 24-hour average HR in bereave

Figure 4. vWF-ag levels

and 24-hour average HR in bereaved participants at 2 weeks (entry) and 6 check details months compared with nonbereaved controls in the Cardiovascular Health in Bereavement Study.42 vWF, von Willebrand factor Elevated HR in bereavement may be a significant contributor to health risk in early bereavement as higher HR has been linked to greater cardiovascular risk and mortality45,46 and coronary artery plaque rupture.47 In one study of patients with existing heart disease, an increase of five beats per minute in a 24-hour assessment, as seen in the acutely bereaved participants in the CAREER study,42 increased the risk of new coronary events by 14%, Inhibitors,research,lifescience,medical after controlling for the Inhibitors,research,lifescience,medical other risk factors.48 Lower HR found in those taking HR-lowering medications in the CARBER study,42 while not surprising, would suggest that these medications could be cardioprotective during early bereavement,49 especially in those who are at significant cardiovascular risk. Blood pressure Traumatic grief symptoms 6 months after the death of a spouse predicted higher self-reported blood pressure (BP) at 13- and 25-month follow-up Inhibitors,research,lifescience,medical in a prospective survey of 150 widows and widowers.28 Higher clinic systolic BP was reported in a sample of bereaved individuals, compared with a control group, in a longitudinal study of surviving spouses from deceased Alzheimer patients, studied at 6-month intervals for 18 months.50 Longerterm

raised BP was reported in family members of deceased soldiers51 where the stress Inhibitors,research,lifescience,medical of mourning was associated with higher prevalence of hypertension after controlling for other cardiac risk factors.51 Over time, on average 4 years, the proportion of hypertensive participants decreased suggesting that BP takes considerable time to resolve after bereavement.51 More recently, data from the CAREER study42 suggests that raised BP is a prominent physiological feature of bereavement in the early grieving months, as 24-hour Inhibitors,research,lifescience,medical ambulatory monitoring revealed a significantly higher blood pressure load (percentage of day BP above 140 mm Hg) compared with nonbereaved matched controls (39% vs 29%) at both 2 weeks and at 6 months following

loss, with older age independently associated with higher BP levels.42 While short-term hemodynamic changes, as reported above, may have limited clinical significance for healthy younger individuals, small changes could increase risk for older individuals or those with known cardiovascular DNA ligase disease (CVD). For example, a 2-mm Hg reduction in mean systolic BP has been associated with 7% lower CVD and 10% lower risk of stroke and death,52 making BP a potential target for preventative strategies in bereavement. Platelet activation and coagulation factors Increased levels of circulating Von Willebrand factor (vWF) and increased platelet activation have been recently observed in the early weeks of bereavement, with both changes resolved 6 months later (Figure 4).

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