The holidays should be a time when loved ones gather together, sip hot cocoa, and watch chestnuts roasting on an open fire. Too often, however, the holidays are filled with travel delays, shopping lists, and mountains of unwrapped presents on Christmas Eve. The stress of the holidays is enough to give one a heart attack — literally.

A 2004 study published in Circulation, a publication of the American Heart Association (AMA), found that more people die from fatal heart attacks during the last week of December than at any other time of year. Christmas Day is reported to be the most fatal during that week, followed by December 26 and New Year’s Day.

Cold weather, which causes blood vessels to constrict, may be one factor contributing to the increase in heart attacks. On the whole, heart attacks increase by 10% during the colder months, according to Dr. Mitchell S.V. Elkind, M.D., chief clinical science officer for the American Heart Association.

“But on top of that, right at Christmas and New Year’s, there’s a further — about 5% — increase in [the] risk of those events,” Elkind continued.

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However, cold weather is not solely to blame. Research conducted on data from New Zealand and Los Angeles, which enjoy more temperate Christmas weather, also showed that the season of giving is fraught with increased heart attack risks even in warmer climates.

Though researchers could not pinpoint a singular cause for what some have called the “Merry Christmas Coronary” or the “Happy New Year Heart Attack Phenomenon,” the study suggested that emotional stress associated with the holidays, inappropriate delays in seeking treatment, and changes in diet and alcohol consumption are possible explanations for the uptick in deaths.

Last month, the AMA issued a press release warning Americans about the increased risk of cardiac events and how to safely celebrate this upcoming holiday season.

Dr. Donald Lloyd-Jones, M.D., president of the non-profit AMA, urged Americans to exercise moderation during the holidays.

“The holidays are a busy, often stressful, time for most of us. Routines are disrupted; we may tend to eat and drink more and exercise and relax less. We also may not be listening to our bodies or paying attention to warning signs, thinking it can wait until after the new year,” Lloyd-Jones said. “All of these can be contributors to increasing the risk for heart attack at this time of the year.”

To avoid becoming a statistic, the American Heart Association suggests:

  • Celebrate in moderation
  • Remember to relax and get plenty of sleep and exercise
  • Continue medication routine
  • Know common warning signs of a heart attack, such as chest pain, nausea, shortness of breath, and heart palpitations. If a person’s heart stops beating, immediately start “hands only” CPR and call 9-1-1.