Married Patients Recover Better From Heart ProblemsFriday, 20 Sep 2013
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 counterparts.
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.
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 other illnesses.
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 analyzed the records of 11,216 patients gathered
over 18 years through telephone contact or office visits. The
patients' average age was 64, and 55 percent were married while 45
percent were unmarried. The singles group included people who were
never married, widowed or divorced; 65 percent of them were men, 66
percent were white and 26 percent 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 percent of unmarried patients dying in the hospital, compared to
0.4 percent of married patients, according to the results published
in American Heart Journal.
Within 30 days of their procedures, 3.1 percent of unmarried
patients had major cardiovascular events, compared to 1.2 percent of
marrieds. At one year, 13.3 percent of singles versus 8.2 percent of
marrieds 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 physiological effects.
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 behaviors can
lead to biological changes that can increase the risk and severity
of heart disease.
"We know that most of this is about health behaviors," 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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