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Holiday Heart Syndrome Spikes Heart Attack Risks

Doctors explain why the end of the year, especially Christmas Day, can be tough on your ticker

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For most of us, the holidays are a time of celebration. But along with all the roasted ham and spiked eggnog, there’s a very real health concern: holiday heart syndrome. 

Research shows that more people die from heart attacks during the last week of December than any other time of the year. According to a study published in the journal Circulation, more cardiac deaths occur on Dec. 25 in the United States than any other day of the year, followed by Dec. 26 and Jan. 1. 

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“No one wants to think of tragedy during this joyous time of year as we gather with family and friends. However, these startling facts are very sobering. We don’t know exactly what triggers this increase in heart attacks during the holidays; it’s likely a combination of factors,” said Johanna Contreras, M.D., a cardiologist at Mount Sinai Hospital System in New York City. 

In fact, the number of heart-related deaths in the United States increases by about 4 percent during the December and New Year holidays, according to a 2016 study published in the Journal of the American Heart Association. A 2018 analysis published in the British Medical Journal found that the risk of having a heart attack is about 37 percent higher on Christmas Eve with people over the age of 75 and those with chronic health conditions such as heart disease or diabetes at greater risk. 

“During December, people take a holiday from taking care of their health, which isn’t good for their hearts,”  says Nieca Goldberg, medical director of Atria NYC and a clinical associate professor of medicine at New York University.

Why the holidays are harmful

This time of year can be so tough on your ticker for a few reasons. They include:

  • Stress. Whether it’s the bustle of holiday travel, or feeling financially overstretched from shopping for gifts, this time of year can put a lot of strain on your body. “When you’re stressed, your brain produces more stress hormones such as cortisol, which are bad for heart health,” says Donald Lloyd-Jones, M.D.,  former president of the American Heart Association. In fact, people with high levels of cortisol are five times more likely to die of a heart attack or stroke, even if they don’t already have heart disease, according to research published in the Journal of Clinical Endocrinology and Metabolism.
  • Depression. The holiday blues are common, and older adults may be even more vulnerable if they are continuing to limit in-person contact with others because of the COVID-19 pandemic, Lloyd-Jones notes. A 2020 study published in JAMA Psychiatry found that deaths from heart disease increased by 20 percent among people with at least four symptoms of depression, compared with people without. 

“The holidays are hard for older adults, who may not have as much social support as they did when they were younger, and thus feel lonely and isolated,” says Waqar Khan, an interventional cardiologist and author of Be Heart Smart: Understand, Treat, and Prevent Coronary Heart Disease. And the same emotions that leave you feeling anxious and frazzled can also raise levels of hormones such as norepinephrine and adrenaline, which in turn can raise your blood pressure and heart rate enough to boost your heart attack risk. 

  • Skimping on health. You may find yourself so busy this time of year that you forget to take your medications, or have trouble getting to the pharmacy to refill them, says Nicholas Ruthmann, M.D., a cardiologist at the Cleveland Clinic. If you do have unusual symptoms, like chest pressure or shortness of breath, you also may be more likely to put off treatment amid the flurry of all the holidays, he adds.
  • Too much food and drink. A heavy, high-fat, high-salt meal doesn’t just tax your digestive system: It also raises your blood pressure and heart rate, Goldberg says. A 2021 study published in the Annals of Internal Medicine also found that consuming even as little as one drink raises the risk of atrial fibrillation, an irregular heartbeat that affects over 8 percent of adults over the age of 65. “We see a lot of older patients with existing atrial fibrillation who end up in the emergency room with an arrhythmia after a few drinks,” Goldberg says. Even if you don’t have atrial fibrillation, excess alcohol intake can ramp up your blood pressure and blood sugar, raising risk of heart attack or stroke, she adds.

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How to stay safe

If you have heart disease — or have risk factors for it — you don’t have to put the kibosh on holiday celebrating entirely.  

“We do know there are ways to mitigate your risk for a deadly heart attack. So, we encourage everyone to pause during the holiday hustle and bustle and make note of these important steps that could be lifesaving,” says Contreras, who is also a clinical volunteer for the American Heart Association.

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Here are seven things to help make this time of year safer.

1. Plan ahead to make sure you have your medications on hand.

If you know you’ll need medication refills, order them in advance so you aren’t racing around pharmacies during the holidays, Lloyd-Jones says. If you’ve been putting off a doctor visit to check blood pressure, or lab work to check cholesterol or blood glucose levels, do it now.

2. Bundle up against the cold.

The frigid temps can affect your heart, especially if you already have heart disease. “Cold air can raise blood pressure, and also slow down the flow of blood to the heart, which can lead to angina, or chest pain,” Goldberg says. A 2018 study published in JAMA Cardiology found a big jump in heart attacks in the cold, especially when the temperature dips below freezing. Goldberg recommends that you cover your mouth and nose with a scarf to help warm the air you breathe. 

3. Don’t overindulge on holiday meals and treats

Resist the urge to pig out: One study of almost 2,000 heart attack patients found that a single act of overeating could quadruple the chance of having a heart attack on the same day. At holiday celebrations, Goldberg recommends that you skip foods heavy in saturated fat, sugar or salt, and limit yourself to just one cocktail throughout the evening. Binge drinking has been linked to holiday heart syndrome. “When you drink too much alcohol, you can worsen atrial fibrillation,” a condition that causes irregular heartbeat and is present in many older adults, says Khan.

Consider a post-meal walk too: A short walk after eating lowers blood sugar levels more than do walks before a meal, according to a 2018 study published in the medical journal Nutrients.

4. Keep up healthy habits.

Make a pact with yourself during the holidays that you’ll do something good for you every day, whether it’s staying active, getting enough sleep or eating a healthy breakfast every morning. “If you commit to taking care of yourself, you’ll be less likely to slip up with unhealthy habits like smoking, drinking too much or overeating,” Goldberg says.  

5. Avoid overexertion.

Unless you’re in great physical shape, leave the shoveling to a younger family member. Otherwise, if something feels like a physical stretch for you, think twice about taking it on during the holiday red zone. Snow removal can trigger heart attacks. Nearly 200,000 people were treated in emergency rooms for incidents related to snow shoveling from 1990 to 2006, according to a study published in the American Journal of Emergency Medicine. All of the 1,647 deaths recorded in the study were cardiac related. 

6.  Listen to your body.

According to the American Heart Association, the biggest increases in holiday heart attack deaths are among people who are not in a hospital, so it’s important to recognize the symptoms of a heart attack and seek care immediately. “Don’t ignore heart attack warning signs because you don’t want to spoil the holidays, the consequences could be much worse,” American Heart Association Chief Clinical Science Officer Mitchell S.V. Elkind, M.D., said in a news release. 

Symptoms of a heart attack can mimic how you feel after you eat a big meal or rush around, says Ruthmann. Pay attention if you experience signs like shortness of breath or chest pains, especially if these don’t occur right after you’ve eaten. If you notice these, let your doctor know right away. “We find that a lot of people ignore symptoms because they don’t want to miss a certain family dinner or holiday event,” Ruthmann says. “The best gift you can give yourself is to focus on your health.” 

7. Brush up on CPR.

The uptick in heart attacks this time of year “also calls attention to the need for increased awareness of knowing how to perform hands-only CPR,” Elkind said. “You could be out holiday shopping, enjoying an office party or spending time at a family gathering and witness someone having a heart attack and going into cardiac arrest. Starting CPR immediately and calling 911 could be the difference in life or death in those situations. Hands-only CPR is something nearly everyone can learn and do.” The American Heart Association has hands-only CPR tutorials on its website.​

Editor’s note: This story, originally published Dec. 16, 2021, has been updated to include new information.

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