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Professor Ron Grunstein

Professor of Sleep Medicine

MBBS, MD, PhD, FRACP

Israeli study provides evidence of another insidious effect of terror

Posted: December 25, 2014

A paper released today in the prestigious Proceedings of the National Academy of Sciences addresses the long term health risk of fear of terror (FOT). While FOT clearly affects mental health but whether fear exposure elevates cardiac remains unknown. The researchers investigated resting heart rate (pulse), a known modifiable predictor of cardiovascular and all-cause mortality. Changes in basal pulse and pulse variability are tightly associated with sudden cardiac death and all-cause mortality but pulse is a complex measure affected by a range of health, genetic, environmental, and other factors.

Israel has been exposed to the repeated stress of multiple wars and terror attacks for more than 60 y, with a major impact on the entire society. The researchers from the Hebrew and Tel-Aviv universities determined parameters related pulse rate and its annual change in the Israeli population. The researchers used data collected as part of the “TAMCIS: Tel Aviv

Medical Center Inflammation Survey.” Study participants (10,972 men and 6,408 women) were all apparently healthy employees, attending a center for periodic health examinations, for a routine health examination during the years 2002–2013.

Palestinian Suicide Bombing

FOT was assessed by three items (“Nowadays, I worry about my personal safety.” “Nowadays, I feel heightened tension when I am in crowded places.” “I am afraid of a terror strike harming me or my family.”). For each item, participants checked off one of the following responses: “not at all,” “a little bit,” “moderately,” “quite a bit,” and “extremely.” The scores on these items were averaged to yield a continuous FOT score (range, 1–5).

The investigators had a wide range of questionnaire survey data on psychological and general health variables as well results of blood tests and measures of an overactive sympathetic nervous system in some.

In brief, they found FOT combined with the inflammatory blood marker C-reactive protein as prominent co-regulators of observed annual pulse increases. The authors state that this is the first statistics-based search for the major interactions between physiological and psychological determinants of basal pulse and annual pulse changes; their research indicates, “perhaps not surprisingly, that consistent exposure to terror threats ignites fear-induced exacerbation of pre-existing neuro-immune risks of all-cause mortality”

These data provide findings that also may be useful in identifying asymptomatic people at risk who could benefit from various primary prevention measures eg. increasing physical activity, anti-inflammatory therapy or other measures. It opens open other lines of research including understanding genomic and molecular methods of risk modification for premature death.

Perhaps its important message is the insidious cost of the War on Terror in terms of potential reduction in lifespan by non-traumatic causes. When estimating the economic impact of our efforts in security and fighting terrorism , this may need to be calculated into the cost-benefit analysis.