Stress and Cardiovascular Disease: Lessons From Katrina

Edward D. Frohlich, M.D., F.A.C.C.; Robert S. Schwartz, M.D., F.A.C.C.

Disclosures

Cardiosource 

In This Article

Stress Reactions to Disaster

Common reactions to disaster include a variety of physical and cognitive effects (Slide 2) as well as emotional and interpersonal effects (Slide 3). People who experience extreme peritraumatic stress symptoms (i.e., those symptoms that occur during or immediately after a traumatic disaster experience) are at the greatest risk for delayed or chronic post-traumatic problems such as PTSD and other anxiety disorders, major depression, and substance abuse (Slide 4).

Common Stress Reactions to Disaster: Physical and Cognitive Effects.

Common Stress Reactions to Disaster: Emotional and Interpersonal Effects.

Extreme Peritraumatic Stress Symptoms.

Several large-scale disasters have provided important insight into the impact of extreme stress experiences. In 2005, Hurricane Katrina and subsequent flooding that inundated 80% of the city led to the displacement of approximately 400,000 residents in just the New Orleans area. The confirmed death toll was 1,836 people, mainly from Louisiana (1,577) and Mississippi (238), with an additional 705 people categorized as missing in Louisiana.

In one study, a representative sample of 815 pre-hurricane residents of the areas affected by Hurricane Katrina was interviewed 5-8 months after the hurricane and again 1 year later.[3] Whereas post-disaster mental health problems typically decrease with time, prevalence increased significantly over time for PTSD, serious mental illness, suicidal ideation, and suicide plans (Slide 5). Another report suggested that the slow recovery and failed rebuilding after Katrina set off a "mental health crisis" in the Gulf area.[4] Outcomes were only weakly related to sociodemographic variables,[3,5] meaning that high prevalence of hurricane-related mental illness remained widely distributed in the population 2 years or more after the hurricane.

Prevalence of Post-Disaster Mental Disorders Increased Over Time Following Hurricane Katrina.

Natural disasters also may be followed by increases in myocardial infarction (MI).[6,7] The 1995 Kobe earthquake (known as the Hanshin-Awaji earthquake in Japan) killed 6,434 people and resulted in a three-fold increase of MI in people living close to the epicenter, particularly in women, and a near doubling in the frequency of strokes.[6] One analysis of 15 patients on 24-hour Holter monitoring at the time of a major earthquake found derangement of heart rate variability during the catastrophic event, suggesting one possible mechanism for increased heart attacks.[8] There is evidence, too, that acute catastrophic psychological stress caused by the Kobe earthquake disrupted diurnal cardiovascular variability.[9] This earthquake-induced nondipping might also be related to the nighttime onset of cardiovascular events.

Besides acute events, such as MI, one of the biggest health care challenges following a widespread disaster is meeting the needs of patients with chronic disease. In the New Orleans-Metairie-Kenner, LA, metropolitan area, for example, the prevalence of diabetes was about 9.0%, angina or coronary heart disease 4.6%, previous MI 3.0%, prior stroke 2.0%, and current asthma in 6.3% at the time of Hurricane Katrina.[10] Overall, about 25.4% of adults (or an estimated 233,876 people) had at least one of these conditions.

Finally, changes in behaviors that affect the risk for chronic diseases may occur in the wake of disasters. For example, the U.S. Centers for Disease Control and Prevention noted that individuals in Connecticut, New Jersey, and New York increased smoking and consumption of alcohol following the September 11, 2001 attacks on the New York City World Trade Center.[11]

In this interview, Edward D. Frohlich, MD, FACC, a renowned cardiologist and hypertension investigator, tells his personal story of living through Hurricane Katrina and the lessons learned from this disaster.

(Editor's note: For additional slides and information relating to Stress and Cardiovascular Disease: Lessons From Katrina, click here to access the ACC '07 Rapid News Summary.)

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