Heart attack deaths spike during the winter holidays, with research showing more people die from heart attacks during the last week of December than at any other time of year.

The American Heart Association says Christmas Day sees more cardiac deaths nationwide than any other day, followed by December 26 and New Year’s Day. Studies show the risk increases during the holidays, especially for older adults and people with heart disease or diabetes.

Doctors say cold weather, added stress, rich foods, alcohol, and missed medications may all play a role. In rural areas, where emergency response times can be longer, recognizing symptoms and calling 9-1-1 quickly is critical.

Health officials also encourage families to learn Hands-Only CPR, noting most cardiac arrests happen outside the hospital.

More heart-healthy tips are available at heart dot org.