Marriage reduces heart attack risk
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Conversely, said 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 was based on the FINAMI myocardial infarction register data from the years 1993 to 2002. It 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 population database. "Our aim," said the researchers, "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 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. However, the analysis also showed that the age-standardised incidences of these ACS events were approximately 58–66 percent higher among unmarried men and 60–65 percent higher in unmarried women, than among married men and women in all age groups.
The differences in 28-day mortality rate were even greater. These 28-day mortality rates were found to be 60–168 percent higher in unmarried men and 71–175 percent higher in unmarried women, than among married men and women.
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 researchers, 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 researchers stated.
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," they said.
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 hospitalisation. 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," they added.
However, lead author Dr Aino Lammintausta from Turku University Hospital in Finland also noted that these differences in prognosis cannot be fully explained by differences in treatment-seeking time or access to effective therapy.
The study has been published in the European Journal of Preventive Cardiology.