Docs: Katrina stress still causing heart attacks?

Published 12:35 am Sunday, March 29, 2009

Stress following Hurricane Katrina may still be causing heart attacks years after the storm slammed Louisiana, according to a new Tulane University study.

Tulane University Hospital and Clinic has seen a threefold increase in the percentage of heart attack patients since the August 2005 storm, doctors wrote in a brief report to be presented Sunday at the American College of Cardiology meeting in Orlando, Fla.

Dr. Anand Irimpen, cardiologist and senior author of the study, is the first to note that the study is too small to prove cause and effect.

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Even so, most cardiologists in the area believe there has been such an effect, said Dr. Carl “Chip” Lavie, medical director for cardiac rehabilitation and prevention at Ochsner Health System.

“Everyone feels they’ve lived this,” he said.

Many studies have documented increases in heart attacks after a major catastrophe. But this may be the first time anyone has found such an increase more than two years later, Lavie said.

Of 21,229 patients seen at Tulane in the two years before Katrina, 150 were treated for heart attacks, compared with 246 out of 11,282 in the two years after the hospital reopened in February 2006 — a change from just more than 0.7 percent to nearly 2.2 percent.

Post-Katrina heart attack patients also were more likely to need operations and less likely to have jobs or medical insurance than their pre-storm counterparts. They were more likely to smoke or to abuse drugs or alcohol, and less likely to be taking medicine prescribed to ward off strokes or heart attacks. They were more likely to be local residents rather than visitors, and to be living in temporary housing.

Because the study looked at a small number of patients at a single hospital, many questions remain open.

“Is Tulane seeing more heart attacks now because of Katrina, or are the heart attacks coming to Tulane that would have gone someplace else before the storm?” asked Lavie.

The two hospitals nearest Tulane’s are still shuttered. Both treated people at high risk for heart attacks: indigent patients at Charity Hospital, and older patients at the Veterans Affairs hospital. VA doctors now work for the agency in Tulane facilities, VA spokesman Robert Goza said.

Irimpen, who also worked at the VA hospital and both public hospitals — University Hospital has reopened — said he suggested the study because he was being called in much more often to treat heart attack patients.

The next step, he said, was a citywide study.

Irimpen said possible reasons for an increase in heart attacks include not only stress from the storm and its effects like unemployment, but bad habits that increase under stress, such as smoking, substance abuse and failing to take prescribed medicines.

“We’ve seen patients who had quit smoking and started again, patients who were exercising and say they haven’t exercised since Katrina,” Lavie said. Many have stopped taking blood pressure, cholesterol or other heart-related medicines.

“Some because they couldn’t easily get a refill. Some because their doctor’s office closed down. Some because they just got swamped with personal things to deal with. … All they cared about was dealing with FEMA and dealing with their flooded house and their mom’s flooded house and their sister’s or kids’ flooded house,” he said.

As the nation’s worst natural disaster, Hurricane Katrina has been a fertile ground for medical and psychiatric studies of stress. Other studies have looked at death rates, post-traumatic stress disorder and mental health in general.

Irimpen’s is one of the few multiyear studies of stress caused by war, terror or disaster and the heart, said Dr. Lori Mosca, director of preventive cardiology at New York Presbyterian Hospital. “Maybe even the current economic crisis can roll into this category,” she said.

“I think this is an important, important study from that perspective,” Mosca said. “It really underscores the long-term adverse effects of disasters and chronic stress on the heart.”

Tulane Medical Center: