Higher cardiac mortality in the winter has long been recognised. It may be due to colder temperatures, which have been associated with depression of heart rate variability and increases in vascular resistance, coronary vasospasm, blood pressure and haemostasis. The peak in cardiac mortality around Christmas and New Year is likely to be compounded by factors that accompany the holiday season: overindulgence in food, salt and alcohol, emotional stress or depression, exposure to particulates from fireplaces, holiday-induced delays in seeking medical attention and reduced staffing of healthcare facilities. How can we help our patients to reduce their risk?
