Marriage Reduces Risk of Heart Attack in Both Men
and Women and of All Ages
Cohabiting associated with better prognosis after
coronary events before and after hospitalization
Jan. 31, 2013 - A large population-based study
from Finland shows that being unmarried increases the risk of fatal
and non-fatal heart attack in both men and women whatever their age.
Conversely, say the study investigators, especially among middle-aged
couples, being married and cohabiting are associated with "considerably
better prognosis of acute cardiac events both before hospitalization and
after reaching the hospital alive".
The study included information on
people over the age of 35 living in four geographical regions of
Finland. All fatal and non-fatal cardiac events - known as "acute
cardiac syndromes", ACS - were included and cross-referred to the
"Our aim," said the authors, "was to study the
differences in the morbidity and prognosis of incident acute coronary
syndromes according to socio-demographic characteristics (marital status
and household size)."
The study, published today in the European Journal of Preventive
Cardiology, was based on the FINAMI myocardial infarction register
data from the years 1993 to 2002.
The register recorded 15,330 ACS events over the study period of ten
years, with just over half (7703) resulting in death within 28 days.
Events occurred almost equally among men and women.
analysis also showed that the age-standardized incidences of these ACS
events were approximately 58–66% higher among unmarried men and 60–65%
higher in unmarried women, than among married men and women in all age
The differences in 28-day mortality rate were even greater. These
28-day mortality rates were found to be 60–168% higher in unmarried men
and 71–175% higher in unmarried women, than among married men and women.
For example, the 28-day ACS mortality rate in 65
through 74-year-old married
men was 866 per 100,000 persons per year but 1792 per 100,000 per year
in unmarried men. This rate did not differ according to previous marital
Similarly, mortality rates among 65-74-year old married women were
247 per 100,000 persons per year, but 493 per 100,000 when the woman was
Statistically, the figures represented a 28-day "case
fatality" rate of 26% in the 35-64-year-old married men, 42% in men who
had previously been married, and 51% in never-married men. Among women,
the corresponding figures were 20%, 32%, and 43%.
Consistent with this finding, the case fatality rate of
35-64-year-old single men and women was higher than that of those living
with one or more people.
According to the authors' background to the study, being unmarried or
living alone is known to increase total and cardiovascular mortality and
cardiovascular disease incidence. However, many of these previous
studies have included only men in their analysis, with missing data on
women and older age groups.
Why should single living or being unmarried be associated with such a
greater susceptibility to coronary events, and particularly fatal
events? The authors suggest several possibilities:
Differences in the prevalence of traditional cardiovascular risk
factors. "We cannot exclude the possibility that persons with poor
health status may be more prone to staying unmarried or getting
divorced," the authors state.
Married people may be better off, have better health habits, and
enjoy higher levels of social support than the unmarried, which will
all promote their overall health.
Better prospects in the pre-hospital phase because of earlier
intervention. "It may be assumed that resuscitation or calling for
help was initiated faster and more often among those married or
cohabiting," say the authors.
Better treatment once in hospital and after discharge. "We found
that a larger proportion of married and cohabiting men received
reperfusion therapy at acute stage which may contribute to their
better survival after hospitalization. Lower adherence to secondary
preventive medications (aspirin, statins, beta-blockers, angiotensin
converting enzyme inhibitors or angiotensin receptor blockers) among
the unmarried may have an adverse effect on long-term prognosis,"
However, lead author Dr Aino Lammintausta from Turku University
Hospital in Finland also notes that these differences in prognosis
cannot be fully explained by differences in treatment-seeking time or
access to effective therapy. The socio-demographic differences reflected
in the study's results are a "considerable population health problem",
she said, which warrants further research to explain.
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