Marital status appears to influence cardiovascular disease (CVD) and prognosis, according to the largest yet meta-analysis. Not being married was associated with heightened risk of developing CVD and coronary artery disease, and with a heightened risk of dying from coronary heart disease (42%) and stroke (55%).
The findings prompt the researchers at the University of Keele, Royal Stoke Hospital, Stoke-on-Trent, University of Arizona College of Medicine-Phoenix, Royal North Shore Hospital, St Leonards and Macquarie University, Sydney, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia and the University of Aberdeen to suggest that marital status should be included as a risk factor for heart disease/stroke and likely survival in its own right.
Most (80%) cardiovascular disease can be attributed to well known risk factors: age; sex; high blood pressure; high cholesterol; smoking; and diabetes. But it’s not clear what influences the remaining 20%.
The findings of previous research on the impact of marital status have been somewhat mixed, so in a bid to clarify the issues, the authors trawled research databases for relevant published studies.
They drew on 34 out of a total of 225, all of which had been published between 1963 and 2015 and involved more than 2m people aged between 42 and 77 from Europe, Scandinavia, North America, the Middle East, and Asia.
Pooled analysis of the data revealed that, compared with people who were married, those who weren’t (never married, divorced, widowed) were at heightened risk of developing cardiovascular disease (42%) and coronary artery heart disease (16%).
Not being married was also associated with a heightened risk of dying from both coronary heart disease (42%) and stroke (55%).
When the data were broken down further, the analysis showed that divorce was associated with a 35% higher risk of developing heart disease for both men and women, while widowers of both sexes were 16% more likely to have a stroke.
While there was no difference in the risk of death following a stroke between the married and the unmarried, this was not the case after a heart attack, the risk of which was significantly higher (42%) among those who had never married.
The authors caution that the methods used and adjustments made for potentially influential factors varied considerably across all the studies, which may have affected the results of their analysis. Similarly, there was no information on same sex partnerships or the quality of marriage, and the potential role of living with someone, as opposed to being married to them, was not explored.
But this is the largest study to date, with the age and ethnicity of the participants strengthening the wider applicability of the findings, the authors point out.
And there are various theories as to why marriage may be protective. These include earlier recognition of, and response to, health problems; better adherence to medication; better financial security; enhanced wellbeing; and better friendship networks.
“Future research should focus around whether marital status is a surrogate marker for other adverse health behaviour or cardiovascular risk profiles that underlies our reported findings or whether marital status should be considered as a risk factor by itself,” the authors conclude.
Abstract
Background: The influence of marital status on the incidence of cardiovascular disease (CVD) and prognosis after CVD is inconclusive. We systematically reviewed the literature to determine how marital status influences CVD and prognosis after CVD.
Methods: A search of MEDLINE and Embase in January 2018 without language restriction was performed to identify studies that evaluated the association between marital status and risk of CVD. Search terms related to both marital status and CVD were used and included studies had to be prospective in design. The outcomes of interest were CVD, coronary heart disease (CHD) or stroke incidence and mortality. We performed random effects meta-analysis stratified by the types of population by calculating odds ratios (OR) and 95% confidence intervals (95% CI).
Results: Our analysis included 34 studies with more than two million participants. Compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42; 95% CI 1.00 to 2.01), CHD (OR 1.16,95% CI 1.04 to 1.28), CHD death (OR 1.43,95% CI 1.28 to 1.60) and stroke death (OR 1.55,95% 1.16 to 2.08). Being divorced was associated with increased odds of CHD (P<0.001) for both men and women while widowers were more likely to develop a stroke (P<0.001). Single men and women with myocardial infarction had increased mortality (OR 1.42, 95% CI 1.14 to 1.76) compared with married participants.
Conclusions: Marital status appears to influence CVD and prognosis after CVD. These findings may suggest that marital status should be considered in the risk assessment for CVD and outcomes of CVD based on marital status merits further investigation.
Authors
Chun Wai Wong, Chun Shing Kwok, Aditya Narain, Martha Gulati, Anastasia S Mihalidou, Pensee Wu, Mirvat Alasnag, Phyo Kyaw Myint, Mamas A Mamas
[link url="https://www.bmj.com/company/newsroom/marriage-may-protect-against-heart-disease-stroke-and-associated-risk-of-death/"]BMJ material[/link]
[link url="https://heart.bmj.com/content/early/2018/06/06/heartjnl-2018-313005"]Heart abstract[/link]
[link url="https://heart.bmj.com/content/early/2018/06/07/heartjnl-2018-313469"]Editorial[/link]