- Researchers suggest that marital status should be included as a risk factor for heart disease/stroke and likely survival in its own right
- The single, divorced, and widowed at heightened risk
A global study led by Keele University in the United Kingdom in collaboration with Macquarie University has found that marriage may protect against the development of heart disease and stroke as well as influencing who is more likely to die of it.
The findings, from a pooled analysis of the available data, published in the journal Heart, prompt the researchers 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 per cent) 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 per cent.
The research was led by Keele University in collaboration with Dr Anastasia Mihailidou from the Department of Biomedical Sciences at Macquarie University and Kolling Institute, Royal North Shore Hospital, the Universities of Aberdeen and Arizona, University Hospitals of North Midlands NHS Trust (UHNM) and the King Fahd Armed Forces Hospital.
The study’s senior author, Professor Mamas Mamas, Professor of Cardiology at Keele University and consultant cardiologist at the Royal Stoke University Hospital, said: “Our work suggests that marital status should be considered in patients with or at risk of developing cardiovascular disease, and should be used alongside more traditional cardiac risk factors to identify those patients that may be at higher risk for future cardiovascular events.”
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 studies, all of which had been published between 1963 and 2015, and involved more than two million 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 were not (never married, divorced, widowed) were at heightened risk of developing cardiovascular disease (42 per cent) and coronary artery heart disease (16 per cent).
Not being married was also associated with a heightened risk of dying from both coronary heart disease (42 per cent) and stroke (55 per cent).
When the data were broken down further, the analysis showed that divorce was associated with a 35 per cent higher risk of developing heart disease for both men and women, while widowers of both sexes were 16 per cent 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 per cent) among those who had never married.
Macquarie University researcher Dr Anastasia Mihailidou from the Department of Biomedical Sciences said: “Our analysis showed that compared to married individuals, being unmarried was associated with increased coronary heart disease and both cardiovascular heart disease and stroke mortality in the general population.”
The important message is to evaluate patients’ social circumstances including marital status and consider the need for additional support as part of management.
Lead researcher, Chun Wai Wong, from Keele University concluded: “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.
Wong CW, Kwok CS, Narain A, et al. Marital status and risk of cardiovascular diseases: a systemic review and meta-analysis. Heart. doi 10.1136/heartjnl-2018-313005Subscribe for Media Release updates