Caring for a family member with a serious heart ailment may increase your risk of cardiac disease

Mar 13 2008

Caring for a family member with a serious heart ailment may increase your risk of cardiac disease, according to a report presented at the American Heart Association's 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

Researchers examined heart risk factors in family members of cardiac patients and found that those who provided all or most of a patient's care had higher levels of risk factors for heart disease than non-caregivers and those who reported higher caregiver strain after six months were more likely to be depressed than those who provided less or no care. There is growing evidence that suggests stress and depression may play an important role in the development of cardiovascular disease.

“It appears that cardiac caregivers may be at increased risk of cardiac diseases themselves,” said Lori Mosca, M.D., Ph.D., senior author of the study and professor of medicine and director of preventive cardiology at New York–Presbyterian Hospital/Columbia University Medical Center. “When a cardiac patient is hospitalized, there may be a unique opportunity to identify and help family members at risk of heart disease themselves.”

In a second study, Mosca and her colleagues found that educating caregivers and family members of hospitalized cardiac patients about their own heart risks and providing them information about a heart-healthy diet improved their eating habits after six weeks.

The researchers conducted both studies as part of the ongoing National Institutes of Health-sponsored Family Intervention Trial for Heart Health (F.I.T. Heart), for which Mosca is the principal investigator. She said participants in the trial will be followed for one year.

“As doctors, we need to recognize that cardiac caregivers may be at increased risk of heart problems,” Mosca said. “And there is a high prevalence of cardiac caregivers that we can identify who may potentially benefit from education and outreach programs.”

Prior to launching F.I.T. Heart, she and her team reviewed medical studies related to the health issues of people providing care to family members with chronic problems.

“Almost everything we found was on Alzheimer's disease, cancer or disabled children,” Mosca said. “We found very few studies on the risks of cardiac caregivers.”

For F.I.T. Heart, researchers recruited 501 family members or co-habitants of patients hospitalized for such cardiac events as a heart attack or narrowed arteries that required bypass surgery or an angioplasty procedure. Six months later, researchers determined the approximate time each spent as a caregiver, and assessed their lifestyles, psychological strain and whether they were depressed.

For their analysis, the team designated 39 percent of the sample as primary caregivers (those who provided care all or most of the time), 11 percent were caregivers most of the time, 32 percent were caregivers some of the time or occasionally, and 17 percent were caregivers none of the time. Caregivers were significantly more likely than non-caregivers to be women (63 percent), married or living with someone, older than age 50, unemployed and people who did not complete high school. They were also less likely to adhere to heart risk-reduction dietary guidelines than non-caregivers, consuming significantly more saturated fat and having larger waist measurements. Mosca said the team identified several characteristics of caregivers that increase their risk for heart disease.

The average strain scores of caregivers six months after their loved ones were hospitalized were significantly higher among those with depression and low social support, even after the researchers adjusted for gender, marital status and levels of depression and social support at enrollment.

“There is an association between depression and higher caregiver strain,” Mosca said. “We don't know if high caregiving strain leads to depression or if depression makes you more strained.”

Researchers hypothesized that family members of a hospitalized heart patient might think at the time about their own risk of cardiac disease. If so, “this is a motivational moment and a unique opportunity to educate them and help them lower their risks,” Mosca said.

In the second study, participants in F.I.T. Heart received dietary advice on how to reduce their heart risks, most of them during the time the patient was in the hospital.

Six weeks later, the family members showed a significant increase, 79 percent versus 53 percent at enrollment, in the number following the National Heart, Lung, and Blood Institute's Therapeutic Lifestyle Change diet. The diet restricts saturated fat to 7 percent of calories consumed, total fat to less than 30 percent of calories, and cholesterol to 200 milligrams per day.

Researchers found that participants' willingness to change their eating patterns was predicted by high blood glucose or triglycerides at enrollment, a perception of poor health and a younger age.

“It's important that we develop more systematic approaches to identifying caregivers, educating them and providing them with the proper support systems,” Mosca said. “If a caregiver dies of a heart attack, it's not going to help the cardiac patient.”