White knuckles. Racing pulses. Grinding teeth. Clenched fists.
It's no secret that emotions will be running high both on and off the field this Superbowl Sunday. But along with the well-known emotional rollercoaster ride brought about by the thrill of victory — or the agony of defeat — may come certain heart risks. So says a new study published Wednesday in the New England Journal of Medicine.
Researchers looked at the occurrence of heart emergencies during another major sports event — the 2006 World Cup, which Germany hosted in June and July of that year. Specifically, the researchers concentrated on the number of cardiac events reported by German soccer fans who watched the games.
They found that heart emergencies more than doubled on days the German team played.
Moreover, among men, the number of heart emergencies tripled on these days. In particular, the study suggests, the risk of heart attack increased by 250 percent and risk of irregular heartbeat increased by more than 300 percent for these fans.
Thus far, there is no research that shows definitively that fans of American football face these same heart risks. However, heart experts say it's likely — and that Sunday's culmination of the NFL season could pose a special risk for those who have heart issues.
"The excitement of watching the upcoming Super Bowl could put some individuals at risk of an acute heart problem including heart attack, death or an irregular heart rhythm," says Dr. Lori Mosca, professor of medicine and director of preventive cardiology at NewYork-Presbyterian Hospital and Columbia University Medical Center.
"The old joke is that many wives across the nation will become 'football widows' that day," notes Dr. Richard Luceri, a cardiac electrophysiologist and vice president of medical services for JM Family Enterprises in Deerfield Beach, Fla. "But this new report is the first valid and statistically significant study verifying how high emotions and acute stress while watching major sporting events actually do increase the risk for heart emergencies."
The German study is far from the first to draw links between emotional stress — both good and bad — and potentially dangerous heart problems.
Dr. Shukri David, section chief of the division of cardiology at Providence Hospital and Medical Centers, says numerous studies in the past have pointed to a connection between anxiety-generating events and heart problems.
"Stress may be due to the excitement of a sporting event, or natural disasters like hurricanes, marital problems, death in the family or financial crises," David says, adding that this is known as stress-induced cardiomyopathy in the U.S. — and "takotsubo" in Japan.
And some of these studies are recent. "In the mid- to late 1990s, James E. Muller directed the ONSET study, which looked at the activities of patients immediately prior to the onset of their [heart attack]," notes Dr. Peter Schulman, associate professor of cardiology at the University of Connecticut School of Medicine. "It clearly identified emotionally charged activities — including upsetting events, sexual activity, et cetera — as possible precipitants of [heart attack]."
Dr. William O'Neill, executive dean of clinical affairs at the University of Miami's Miller School of Medicine, adds that in his past research, he and his colleagues found that heart rates of deer hunters immediately spike by 30 percent when they spot their prey — yet another demonstration of this principle.
Thus, he notes, the leap to heart problems in Super Bowl fans may not be so far off.
"It may that intense emotional excitement triggers a sudden increase in heart rate that could cause a heart attack in sedentary spectators," O'Neill says. "There is not enough published information in the U.S. about spectator sporting events to make formal recommendations to people in general. Perhaps after this study, we may need to revisit this problem."
But how does this happen? Cardiology experts note that the high anxiety of sports events can set off a chain of physiological reactions that can ultimately lead to heart emergencies.
"Stress hormones are released during the emotional viewing of play-by-play action that can increase blood pressure, heart rate and oxygen demand to the heart, which can lead to problems if the heart is not able to compensate," Mosca says. "Also, emotional triggers like watching the Super Bowl can lead to release of inflammatory molecules and may increase blood clotting, both of which can contribute to an increased risk of a heart attack."
While doctors acknowledge that intense emotion does seem to dial up heart risk, many note that there isn't enough solid evidence yet in the U.S. population to warrant formal recommendations for heart patients who will be watching the Super Bowl.
"We cannot assume that the French will react emotionally-chemically in an identical way to the British or the Germans — let alone Americans... We do not have any conclusive findings regarding Super Bowl and heart attacks," says Dr. David Prince, director of the cardiac recovery program at Montefiore Medical Center in New York.
Still, cardiologists say many fans would do well to take the findings to heart.
"Fans with heart disease should be careful," says Dr. Robert J. Myerburg, American Heart Association chair in cardiovascular research and professor of medicine at the University of Miami. "Unfortunately, somewhere between 33 percent and 50 percent of all sudden cardiac deaths occur as first events — so a lot of people can't be forewarned."
And even with appropriate warning, what die-hard Giants or Patriots fan would miss the big game?
Fortunately, there are steps that those with heart problems can take to reduce their risk of heart-related events, notes Dr. Thomas Pearson of the department of community and preventive medicine at the University of Rochester.
"Everyone should have their risk assessed by a health professional and behaviors or conditions that cause that risk to be high should be treated with lifestyle change or medications, as directed by your healthcare provider," Pearson says.
"Americans who feel they may experience stress during major — or minor — sporting or life events should consider taking an aspirin beforehand, " says Dr. John Byrne, professor and chairman of cardiac surgery at the Vanderbilt Heart and Vascular Institute in Nashville, Tenn. "Aspirin, of course, is an over-the-counter, inexpensive and safe medication... This would be very safe, simple and practical for the majority of Americans."
In addition to aspirin, a healthy dose of common sense at the tailgate party or buffet line may be a good idea for some.
"Prior to the Super Bowl, or any other sporting event that may produce stress, cardiac patients should show restraint with regards to unhealthy high fat foods — avoiding pizza, burgers and fried chicken, as well as avoidance of alcohol and cigarette smoke and full compliance with [their] medications," says Dr. Jonathan Whiteson, director of cardiac and pulmonary rehabilitation at the New York University Medical Center.
And, last but not least, those prone to game-time anxiety should remind themselves to take a time out if the action gets too intense.
"My suggestion for patients with severe cardiac disease that are likely to be emotionally invested in the game is not to watch or do so calmly, do not drink, not to violate any dietary restrictions and do not bet on the games," says Dr. Gordon Tomaselli, chief of the division of cardiology at the Johns Hopkins School of Medicine in Baltimore, Md. —