In a new paper published in the Journal of the American Heart Association, he and his team remark that while there is good evidence to suggest that divorced people are more likely to die prematurely, it is not clear whether marital status makes a difference to cardiovascular outcomes in people with heart disease.
They also point out that “the definition of unmarried status is not always clear despite noted differences in the divorced or separated, widowed, and never-married groups.”
Heart disease is the number one cause of death worldwide, claiming a total of 17.3 million lives every year. This number is expected to exceed 23.6 million by 2030.
Often, the first time that people discover that they have heart disease is when they experience a heart attack.
Recruiting those with coronary artery disease
For their study, Dr Quyyumi and colleagues investigated 6,051 adult patients with “suspected or confirmed coronary artery disease” who had undergone cardiac catheterization, which is a diagnostic procedure for examining how well the heart is functioning.
The average age of the participants — 23 per cent of whom were black and 64 per cent were male — was 63 years. They underwent the heart procedure between 2003 and 2015, and they were followed for between 1.7 and 6.7 years, with most being followed for around 3.7 years.
When they underwent cardiac catheterization, 70 per cent of the patients were diagnosed to have blockages, or obstructive coronary artery disease, and 8 per cent presented with heart attack.
From information gathered in telephone interviews and medical records, the researchers found that 18 per cent of the patients had died from all causes over the follow-up period, 11 per cent had died from cardiovascular-related causes, and 4.5 per cent had had heart attacks.
From questionnaires that the study participants had filled in at the outset, the scientists were able to determine that 68 per cent of them were married, 14 per cent were divorced or separated, 11 per cent were widowed, and 7 per cent had never married.
First to look at different unmarried groups
The primary outcome that Dr Quyyumi and colleagues measured was the combined incidence of cardiovascular death or heart attack. They also analysed two secondary outcomes: death from all causes, and cardiovascular death on its own.
They defined cardiovascular death as death that is caused by an “ischemic” event — including, for example, fatal heart attacks or strokes that result from restricted blood supply.
A statistical analysis of the data showed that the risk of dying during the follow-up was higher in the unmarried people than in the married ones.
Specifically, being unmarried was linked to a 24 per cent increased risk of dying from any cause, a 45 per cent increased risk of dying from cardiovascular disease, and a 52 per cent increased risk of cardiovascular death or heart attack.
Further analysis of the risk of cardiovascular death or heart attack among the unmarried patients revealed that the risk was highest for those who had been widowed (71 per cent higher), followed by those who had been divorced or separated (41 per cent higher) and those who were never married (40 per cent higher).
Doctors should consider marital status
The increased risks remained significant “even after extensive adjustment” to take into account other factors that might have an influence on the results, such as disease severity, use of medication, and socioeconomic status.
The team believes that its study is the first to specifically show that the risk of death in widowed, divorced, separated, or never-married patients with suspected or confirmed coronary artery disease is higher than in married patients.
But the researchers also point out that their study has some limitations and should be treated with caution.
For example, the data only covered patients treated at one medical facility, and also, there were no checks during the follow-up of changes in patients’ marital status. There was also no account taken of whether or not patients were cohabiting.
Nevertheless, they suggest that perhaps clinicians ought to take into account marital status when deciding treatment and care of those with coronary artery disease.
They also call for further studies to find out whether “more aggressive treatment strategies” can reduce these risks for unmarried heart patients.
In this group of participants, compared with married people, those who were unmarried were more likely to be black women with high blood pressure, high cholesterol, or heart failure and less likely to smoke.
“Social support provided by marriage, and perhaps many other benefits of companionship, are important for people with heart disease” said Dr Arshed Quyyumi
Source: Medical News Today