New research has linked the death of a sibling early in life to a 17% increased risk of cardiovascular disease, with most being early-onset. The findings highlight the profound impact of bereavement on heart health and the need to provide extra support to grieving siblings to reduce the risk of future health issues.
The sibling relationship is among the longest and most intimate, exerting a unique, profound influence on each other’s development during childhood and adolescence. Previous studies have suggested that the loss of a sibling is a highly traumatic event that may be more disruptive than the loss of other family members. But does that loss produce physical effects such as an increased disease risk?
To answer that question, researchers from Fudan University in China examined the association between the death of a sibling early in life and the subsequent risk of cardiovascular disease (CVD).
The researchers conducted a population-based study that included more than two million Danish individuals, 51.3% were males, with a median age of 11.48 when their sibling died. The outcome of interest was incident early-onset CVD, defined as the first occurrence of CVD before age 41. During the median follow-up period of 17.52 years, 1,286 and 76,862 participants were diagnosed with CVD in the bereaved and non-bereaved groups, respectively. The median age of CVD onset was 22.86 years.
Bereaved participants were found to have a 17% higher risk of overall CVD than non-bereaved participants. The risks of most type-specific CVDs were also increased, with researchers observing a 34% to 66% higher risk of heart failure, myocardial infarction, ischemic heart disease, pulmonary embolism and cerebrovascular disease among participants who’d lost a sibling. The risk was increased whether the sibling died from CVD or non-CVD causes, but the risk of most type-specific CVDs was higher if the sibling died due to CVD.
Regarding the age difference between siblings, the association was stronger for participants who lost a twin or a younger sibling. The increased CVD risk following sibling death was observed in the short- and long-term, regardless of the age at bereavement. However, the researchers noted a more than three-fold increased risk of CVD within the first year following sibling death during adolescence.
“In this cohort study, sibling death in childhood and early adulthood was associated with increased risks of overall and most type-specific early-onset CVDs, and the strengths of these associations varied by cause of death and age difference between sibling pairs,” said the researchers. “The risk was highest shortly after the bereavement, especially for adolescents, but persisted in the long run.”
To the researchers’ knowledge, this is the first population-based study to offer comprehensive insights into the association between sibling death and the risk of overall and type-specific CVD. They proposed some mechanisms that may explain this association.
Their finding that individuals whose siblings died due to CVD had a higher CVD risk supports the hypothesis that common genetic and environmental cardiovascular risk factors present in families are likely an explanation. However, the risk was present when siblings died from non-CVD causes, suggesting factors other than genetics play a role. Psychological stress following bereavement may activate acute stress responses that lead to pathophysiological changes over time. The more intense grief felt following the loss of a twin or a younger sibling may potentially lead to unusual psychophysiological states and abnormal cardiovascular health outcomes.
While the study doesn’t provide direct proof that the loss of a sibling causes heart disease, the findings highlight the need for providing extra attention as well as social and mental health support to bereaved siblings to reduce the risk of CVD later in life.
The study was published in the journal JAMA Network Open.
Source: Fudan University via Scimex