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Married women have lower risk of mortality from heart disease

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Middle-aged women living with spouse or partner have a 28% reduced risk

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Being married has been associated with a lower mortality from ischemic heart disease (IHD) in men, but there is less evidence of an association for women, and it is unclear whether the associations with being married are similar for incident and for fatal ischemic heart disease. A large population-based study from Finland last year showed that being unmarried increases the risk of fatal and non-fatal heart attack in both men and women whatever their age and being married and cohabiting are associated with "considerably better prognosis of acute cardiac events both before hospitalization and after reaching the hospital alive". However, the findings were not adjusted for socioeconomic status or lifestyle factors.

In this new large British study Dr. Sarah Floud, PhD, Post-doctoral Epidemiologist/Social Scientist of the University of Oxford in England, and colleagues examined the relation between marital status and IHD incidence and mortality in the Million Women Study. ? The Million Women Study is a national study of women’s health, involving more than one million UK women aged 50 and over. Among the women 81% reported being married or living with a partner

Researchers used data from the Million Women Study. Their analysis included 734,626 women, average age of 60 years at baseline and without previous heart disease, stroke or cancer.

During 8.8 years of follow-up, 30,747 women had a first IHD event (hospital admission or death) and 2,148 died from IHD.

Women who were married or living with a partner had a similar risk of a first IHD event as women who were not (RR = 0.99, 95% confidence interval (CI) 0.96 to 1.02), but a significantly lower risk of IHD mortality (RR = 0.72, 95% CI 0.66 to 0.80, P <0.0001).

This lower risk of IHD death was evident both in women with and without a prior IHD hospital admission (respectively: RR = 0.72, 95% CI 0.60 to 0.85, P <0.0001, n = 683; and 0.70, 95% CI 0.62 to 0.78, P <0.0001, n = 1,465).

In their conclusion the researchers write “ After adjustment for socioeconomic, lifestyle and other factors, women who were married or living with a partner had a similar risk of developing IHD but a substantially lower IHD mortality compared to women who were not married or living with a partner.”

"In this cohort, unpartnered women tended to live alone, so a possible explanation for the lower risk of death among partnered women may be that they have someone at home who can respond to symptoms and help them seek appropriate treatment," write the researchers.

Also, the presence of a spouse has been shown to encourage their partners to comply with effective medication regimes, facilitate attendance at cardiac rehabilitation programs, and support modification of lifestyle risk factors. Spouses can also provide emotional support to cope with the distress of having had a cardiac event. Another explanation for the improved survival after hospital admission among partnered women is that they may tend to have less severe disease on admission to hospital, but we were unable to assess this due to lack of data on disease severity.

Partnered women were also less likely to report that they had been treated for depression or that they were rarely, never or (only) sometimes happy. They were more likely to be employed than unpartnered women but less likely to report participation in group activities. "However, we cannot exclude possible roles of unmeasured aspects of social support, such as the frequency of social contact or the quality of social support, “write the researchers.

The researchers acknowledge that they could not rule out residual confounding from other factors either. Disease severity at hospital admission, for example, was not available in the data.

Dr. John Erwin III, MD, Vice-Chair, Department of Medicine, Co-Director, Cardiovascular Fellowship Program of the Scott & White Heart and Vascular Institute in Temple, Texas, and who was not involved in the study commented to MedPage Today The take-away message is that "our species is clearly meant to live in community with one another.” "Relationships clearly play a role in our health and sense of well-being."

This study appears in BMC Medicine.

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