Analysis of surveys of more than 3.5 million American men and women, administered at some 20,000 health centers across the country -- believed to be the largest analysis of its kind ever performed -- found that married people, regardless of age, sex, or even cardiovascular risk factors, had significantly less chances of having any kind of cardiovascular disease than those who were single, divorced or widowed.
Among the study's key findings, to be presented March 29 in Washington, DC, at the annual scientific sessions of the American College of Cardiology:
- Being married carried a 5 percent lower risk of having any cardiovascular disease than being single
- Widowed and divorced people were, respectively, 3 percent and 5 percent more likely to suffer from any kind of cardiovascular disease, including peripheral artery disease, cerebrovascular disease, abdominal aortic aneurysm, and coronary artery disease
- Younger married people, those under age 50, had a 12 percent lower odds of disease than younger single people
- Older couples, between the ages of 51 and 60, had 7 percent reduced risk, while those above 60 had approximately 4 percent lower odds of disease
- For risk factors of cardiovascular disease, smoking was highest among divorced people (at 31 percent) and lowest in widowed people (at 22 percent); and obesity was most common in single and divorced people (at 31 percent and 30 percent, respectively). Hypertension, diabetes and being sedentary were most common in widowed people (at 77 percent, 13 percent, and 41 percent, respectively.)
"Our survey results clearly show that when it comes to cardiovascular disease, marital status does indeed matter," says senior study investigator and NYU Langone cardiologist Jeffrey Berger, MD, MS, director of cardiovascular thrombosis programs and an assistant professor in the Department of Medicine, Leon H. Charney Division of Cardiology. Berger adds that his team's study results, which involved study participants whose age ranged from 21 to 99, suggest that clinicians need to pay attention to marital status when evaluating patients for heart problems. "If one of my patients is recently widowed or divorced, I'm increasingly vigilant about examining that patient for signs of any type of cardiovascular disease and depression," he says.
Dr. Berger says more research is needed to better understand the precise reasons why marital status affects risk of heart disease, but suggested that a pairing such as marriage offers an emotional and physical support system during times of illness and general health. "Married people can look after each other, making sure their spouse eats healthy, exercises regularly, and takes medication as prescribed," he says. "A spouse can also help keep doctors' appointments and provide transportation, making for easier access to health care services."
One of the other important results to come out of the research, according to lead study investigator and NYU Langone cardiology fellow Carlos L. Alviar, MD, is offering clinicians better insight into their patients, particularly how marital status can change their risk of heart disease at different stages in life, from when they get married, when they divorce or become widowed.
Dr. Alviar also points out that the study, an analysis of health center heart-related survey data collected from 2004 through 2008, is particularly important because it is large enough to offer reliable and statistically valid results on marital status' link to disease - and accounted for other known predictors of heart disease. "Patients across the country were monitored through physical exams and imaging tests for different kinds of cardiovascular disease, but also for such risk factors as blood pressure, obesity, smoking history, family history of disease, lack of exercise, blood cholesterol levels, and diabetes," Alviar says. "Most other studies were much smaller in scope, did not look at different age groups, and could not separate marital status and overall disease risk from so many confounding risk factors."
The average age of study participants was 64, of whom 63 percent were female.
Drs. Berger and Alviar plan further analyses to differentiate marital status and reduced risk by race. Although more than 80 percent of study participants were white, the researchers say sufficiently large enough numbers of African-Americans (110,190), Asians (71,090), Hispanics (85,308), and Native Americans (103,081) participated for them to draw specific conclusions based on race and ethnic origin. They also plan to investigate the role of other socio-economic factors, such as education, income, and employment status and how they impact the association between marital status and risk of cardiovascular disease.
Editor's Note: This poster presentation at the American College of Cardiology meeting, #153 is titled "Association of Marital Status with Vascular Disease in Different Arterial Territories: a Population-Based Study of Over 3.5 Million Subjects" and will be on display from 9:30 a.m. to 12:30 p.m., Saturday, March 29, in Hall C at the Washington Convention Center, in Washington, DC.
Funding support for the statistical analysis, which took over a year to perform, was provided by NYU Langone. In addition to Drs. Berger and Alviar, other NYU Langone researchers involved in this study are Caron Rockman, MD; Yu Guo, MA; and Mark Adelman, MD.
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