A new study published in the Canadian Medical Association has found that the days following a heavy snowfall often carry a significantly greater risk of heart attacks for men.

The medical community has long suspected that snow shoveling can increase heart attacks at a population level, yet this study concretely confirms the link between snowfall and heart attacks.

Researchers from the University of Montreal gathered reports of 128,073 hospital admissions and 68,155 deaths from heart attacks in Quebec between the months of November and April, every year between 1981 and 2014. The team also obtained weather information that corresponded to the time frames and regions included in the study.

When comparing the medical and weather data, the researchers found that the most dangerous days occurred immediately following snowfalls: almost one third of all hospital admissions and deaths due to heart attacks occurred on these days. Moreover, the risk was even greater subsequent to snowfalls that lasted two to three days.

The findings serve as a reminder that people should remain vigilant about potential cardiovascular risks, in addition to automobile accidents and snow-related falls. Furthermore, snow shoveling is challenging for the heart, and can pose an extreme strain and danger if overdone.

Because the study analyzed trends over time, it did not establish a specific cause-and-effect relationship between snow-related activities like shoveling and heart attacks. Yet the authors’ hypothesis—that men are more likely to shovel post-snowstorm, and that shoveling is responsible for the increased risk of heart attacks—is more than plausible, and reason enough to approach shoveling with care and caution.

The study further indicates that the physical exertion and cold temperatures associated with shoveling snow set the stage for an “eco-biological-behavioral perfect-storm,” particularly for those out of shape, or people with other heart disease risk factors.

While shoveling is likely the primary reason that heart attacks increase after a snowstorm, it is critical to be mindful of heart health all year round. In addition to avoiding shoveling, people should also be physically active and have a nutritious diet.

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