When news broke that celebrated architect Zaha Hadid died last Thursday in a Miami hospital, fans may have been surprised to read that she suffered a sudden heart attack while being treated for bronchitis.
A statement from her architecture firm in London said Hadid contracted bronchitis earlier in the week in Miami, and had a heart attack while hospitalized for it.
The Baghdad-born architect was the first woman and first Muslim to win the prestigious Pritzker Architecture Prize and among her many other awards was the Royal Institute of British Architects’ 2016 Gold Medal. Her designs, which were renowned for their bold, sweeping curves, include the London Aquatics Centre, the Guangzhou Opera House and the MAXXI National Museum of the XXI Century Arts in Rome.
But one small part of her legacy may be what her death teaches us about heart attack risk. Hadid’s death is a reminder that it can fluctuate depending on other health circumstances, and seemingly unrelated conditions like respiratory infections can increase the risk of a heart attack, especially in older adults.
A heightened risk of stroke and heart attack
Doctors have long observed that infections appear to trigger heart attack and stroke: In 2004, London researcher Liam Smeeth confirmed that heart attack and stroke risk does indeed rise a few days after being diagnosed with the flu, pneumonia or bronchitis.
Smeeth found that being diagnosed with a respiratory tract infection was linked to an almost fivefold increased risk of heart attack, and threefold increased risk of stroke within three days. Then, as the infection starts to heal, the risk gradually falls back down to normal levels over several weeks. He wasn’t able to establish a causal relationship back then, but he did hypothesize that short-lived inflammation prompted by infection may disrupt blood vessel health, resulting in higher rates of heart attack and stroke.
At the time the report came out, American Heart Association spokesman Dr. Valentin Fuster noted that while relative risk may rise, the absolute risk of heart attack and stroke is still very small, reported WebMD. In other words, just because you have the flu, that doesn’t mean you’re going to have a heart attack.
Smeeth also emphasized this point in a recent email to HuffPost: "While the risk of having a heart attack does seem to be raised three- to five-fold during a severe infection, in terms of absolute risk the increase is quite small because the effect lasts a few weeks at most," he wrote.
Researchers from Canada followed up on this line of inquiry in 2015 and found that higher risk of heart attack and stroke after a diagnosed infection was most severe for people ages 65 and older. People who were younger still had elevated risk, but it wasn't as high and didn't last as long.
How infection raises the risk of heart attack
Dr. Nisha Parikh, an assistant professor of cardiology at University of California, San Francisco Health says there are a few possible reasons that respiratory infections raise the risk of heart attack. The first is that the infection causes an inflammatory response, which can lead stable plaque in the arteries to rupture and result in a heart attack. Alternately, because it’s harder to breathe with a respiratory infection, the body is getting less oxygen than it needs, which can also strain the heart.
Smeeth added that a combination of dehydration, bed rest and the activation of clotting mechanisms during an infection may make blood clots in blood vessels more likely.
Parikh is not Hadid’s doctor and did not review her case. But she did say the strategies to lower risk from a heart attack after infection are the same you’d undertake to try to avoid heart attack in general.
"Common sense prevention applies here,” she told HuffPost. “Avoid smoking, watch your blood pressure, eat a heart-healthy [diet] and see your primary care physician for regular preventive check ups, including cholesterol screening."
Heart disease is the leading cause of death for both men and women in the U.S., making up about one in four deaths.
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