More evidence that marriage may benefit overall health comes
from findings that in the first year after having blocked blood vessels leading
to the heart cleared, married patients fared much better than their unmarried
Even after researchers adjusted for other cardiovascular
risk factors such as smoking, family history and high cholesterol, unmarried
patients were more than twice as likely to die and to experience major
cardiovascular events like heart attacks, in the year following the procedure,
known as angioplasty.
Heart patients need a lot of support, and their care does
not end in the hospital, the study's senior author, Dr Ron Waksman of the
MedStar Washington Hospital Center in Washington, DC, said. "The implication
is if you do not have someone to take care of you, you should be flagged for
"Previous research has found an apparent health benefit
from marriage, but it is poorly understood and the results are not always
consistent. For instance, bad marriages have been linked to heightened stress
hormones and inflammation, both of which raise risks for heart disease and
Positive marriage effect
But enough evidence suggests a positive marriage effect that
Waksman's team set out to try to measure it in patients getting angioplasty to
clear blocked coronary arteries – either to stave off a heart attack or as a
result of already having had one.
The researchers analysed the records of 11 216 patients
gathered over 18 years through telephone contact or office visits. The
patients' average age was 64, and 55% were married while 45% were unmarried.
The singles group included people who were never married, widowed or divorced;
65% of them were men, 66% were white and 26% were African American.
Although high cholesterol and family history of heart
disease were both more common among married individuals, it was the singles who
were more likely to have major heart problems – including death, a heart attack
or need for another angioplasty – in the year following their procedure.
The trend started right after patients underwent angioplasty,
with 1.1% of unmarried patients dying in the hospital, compared to 0.4% of
married patients, according to the results published in American Heart Journal.
Within 30 days of their procedures, 3.1% of unmarried
patients had major cardiovascular events, compared to 1.2% of married patients. At one
year, 13.3% of singles versus 8.2% of married patients had major cardiovascular events,
and singles were also more than twice as likely to die of any cause.
The apparent marriage benefit was more pronounced for men
compared to women. And the researchers caution that the singles were generally
sicker before their procedures, for example they were more likely to have had a
heart attack that prompted the angioplasty.
Theories about the role of marriage in health mainly come
down to the possibility that healthier people tend to get married, or that
spouses take care of one another better than individuals living alone take care
of themselves or that the social and emotional support of a spouse has positive
Waksman thinks the stress-buffering effects of marriage are
important. He also noted that patient compliance, including adherence to a
medication or exercise regimen is generally a major issue in cardiac care, and
that a partner is more likely to assist with this. "What drove us to do
this study is we see that many patients do not adhere to their medications, and
when we ask why we get all kinds of answers," he told Reuters Health.
"These findings should heighten awareness of physicians
to socioeconomic risk factors beyond the standard cardiovascular disease risk
factors and may encourage domestic partners to be more engaged in the health
care process after cardiac interventions," Waksman said.
In another recent study, Harry Reis, professor of psychology
and Kathleen King, professor emerita at the School of Nursing at University of
Rochester, found that married patients were 2.5 times more likely to be alive
15 years after coronary artery bypass surgery compared to unmarried patients.
And the quality of the marriage did make a difference: those with
high-satisfaction marriages were 3.2 times more likely to be alive 15 years
after bypass surgery compared to those reporting low marital satisfaction. But
even unsupportive spouses were better than no spouse at all in their study,
Reis told Reuters Health.
Multiple factors probably account for the marriage benefit,
Reis said, "most likely a combination of spousal support and survivor
motivation to adopt a healthy lifestyle, along with the provision of emotional
support." All this, in turn, could influence physical processes
responsible for slowing the advance of cardiovascular disease, he added.
Mary Whooley, a professor of medicine at the VA Medical
Center in San Francisco, and at the University of California, San Francisco,
said patients with poor social support are less likely to exercise, to eat well
and to seek medical attention.
Whooley, who studies the interactions between depression and
heart health in particular, told Reuters Health unhealthy behaviours can lead to
biological changes that can increase the risk and severity of heart disease.
"We know that most of this is about health behaviours," she said,
noting there are measures that can help people improve their medical adherence
when they do not have a spouse. The important intervention is to ensure that
individuals feel "there is someone they are accountable to".
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