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Health See other Health Articles Title: Bad economy ups heart disease Medscape...Hard Economic Times Hit Greece with More MIs, Atrial Fib ATHENS, GREECE — Tough times in Greece since the world economic meltdown that struck in 2008 have taken their toll on the cardiovascular health of Greek men and women, suggests a pair of reports from one Athens center presented here at the Heart Failure Congress 2014 of the European Society of Cardiology Heart Failure Association. The effects seem to have hit women particularly hard, as well as men without health insurance coverage—which in Greece is covered by a mix of private and public funding and is in general tied to employment. The analyses show that hospital admissions for acute MI and atrial fibrillation (AF) had gone up sharply in 2008–2012, which the reports call the economic "crisis period," compared with the precrisis period of 2003–2007. It was in 2008 that Greece's unemployment rate started a steep climb, conditions that have little improved to this day. "We saw that women, in general, had more heart attacks during the crisis period," Dr Dimitra Papadimitriou (Elpis General Hospital, Athens, Greece), lead author of the MI part of the analysis, told heartwire . "And a subgroup, women younger than 45 years, had a significant increase in acute-MI rates. We assume [this means] that the stress that comes from unemployment and lower quality of life is so strong it can possibly counterbalance the beneficial effects of estrogens that women have during reproductive age, when they're protected against heart attack." And with fewer people employed or able to afford health coverage, many more people in the crisis period compared with before are presenting to emergency rooms with acute MI without coverage, she said. "This is possibly a reflection of the fact that we have a bigger subgroup of patients without social insurance in the general population, and it's only natural that we find more acute MIs in this subgroup, which is now larger." Dr Alexio Samentzas There's abundant literature linking rising rates of MI and other potentially stress-related disorders to populationwide anxiety stemming from natural disasters or wars or other extreme violence, Dr Alexio Samentzas (Elpis General Hospital, Athens, Greece), who led the AF part of the analyses, explained to heartwire . There are also other studies associating cardiovascular events with a bad economy. The current analyses, he said, add to that evidence base by suggesting years of wage reductions, rising unemployment, and hits to national self-esteem may be stressing Greek adults to the point that they are experiencing more MIs and AF, often without the resources to pay for care. The group looked at cardiology-department hospitalizations at one Athens general hospital during the precrisis and crisis periods. In the analysis of MI rates: Rates rose for both men and women from the precrisis to crisis periods, but the increase was statistically significant only for women. Women younger than 45 showed a significant jump in MIs; the rate was essentially flat for men in that age group. The MI rate went up significantly for uninsured men but rose only nonsignificantly for uninsured women. In the analysis of AF rates: Admissions due to AF rose sharply from the precrisis to crisis periods for men and for women; the increase was highly significant for women. AF admissions overall went up in the under-60 age group, with men showing a more pronounced effect. Admissions for AF more than doubled for the uninsured among both men and women. The prevalence of initial AF diagnoses went up for both men and women, especially women. Comparison of Rates of Admission for MI and Atrial Fibrillation in the Precrisis and Crisis Periods, Single-Center Experience End points by subgroups Precrisis Period Crisis period Men Women Men Women Admissions, n 1903 1517 2015 1845 Acute MI (% of admissions) 23.3 14.6 28.2 22.3a <45 years old (% of MI admissions) 14.9 17.6 15.6 22.8b Uninsured (% of MI admissions) 13.7 10 23.4c 13.3 Atrial fibrillation (% of admissions) 15 20 18 27.2a <60 years old (% of AF admissions) 15.7 18.6 27d 26.3 Uninsured (% of AF admissions) 7.3 5.5 15.4 12.7 Initial AF diagnosis (% of AF admissions) 11.9 16.7 16.7 25.5 a. p<0.001 vs precrisis women b. p<0.01 vs precrisis women c. p=0.04 vs precrisis men d. p<0.01 vs precrisis men The message of the two analyses, said Papadimitriou, is primarily for the medical community: doctors in Greece should be more attentive to the prospect of cardiovascular disease in younger people hit hard by the economic downturn, especially "patients who are unemployed and don't have social insurance. We should be by their side more often, and make sure they take their medications—because a big implication of this is that they don't have money to buy their medications." Post Comment Private Reply Ignore Thread
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