January 31, 2013
Unmarried Men And Women At Higher Risk Of Fatal And Non-Fatal Heart Attack
Lawrence LeBlond for redOrbit.com - Your Universe Online
For some, being single has its perks and advantages. For others, marriage is viewed as being more advantageous than living the life as a bachelor or bachelorette. For those people, they may be right in more ways than one. At least two previous studies have shown that married couples, especially those who are happily married, live longer than single people. Now, new research is adding to the mix.
The Finnish study, led by Dr. Aino Lammintausta from Turku University Hospital, and published in the European Journal of Preventive Cardiology (EJPC), suggests that being unmarried increases the risk of fatal and non-fatal heart attack in both men and women at any age. The study researchers said that married couples, notably those who are middle-aged and cohabiting, have a “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 registry of accumulated data from 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 were included and cross-referenced to the population database.
"Our aim 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 authors said in a statement.
The registry recorded 15,330 acute coronary syndrome (ACS) events in the study period, with 7,703 resulting in death within 28 days. The ACS events occurred nearly equally among men and women. However, the data showed that age-standardized incidences of ACS were 58-66 percent higher among unmarried men and 60-65 percent higher among unmarried women, than among married couples in all age groups.
The differences seen in the 28-day mortality rate were even greater, with incidences of deaths related to ACS 60-168 percent higher in unmarried men and 71-75 percent higher in unmarried women. Mortality rates were highest in unmarried men in the 65-74 age group, with 1,792 deaths per 100,000 unmarried men. The rates were highest as well for unmarried women in the same age group, however not nearly as high as unmarried men.
As the ages dropped, so did the mortality rates in all groups, but with married couples still faring much better than their unmarried counterparts. And even in those men and women who were once married, but were now widowed or divorced, mortality rates were still higher than couples who remained married.
According to background information in the study, being unmarried or living alone is known to increase total and cardiovascular mortality and cardiovascular disease incidence. While previous studies have shown similar results to this one, most had been conducted mainly on men, leaving a gap in data for how singularity and older age affects women.
The authors suggest several possibilities why being single is associated with greater susceptibility to coronary events and fatal outcomes.
One possibility could be a difference in 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 authors state.
Another possibility could be that married people are truly better off, having better health habits, and enjoying higher levels of social support than their unmarried peers.
The authors also suggest married couples have 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 noted.
As well, better treatment once in the hospital and after discharge is another likelihood. "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 hospitalization. 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," the authors added.
Lammintausta noted that the differences in prognosis cannot be fully explained by differences in treatment-seeking time or access to effective therapy. She said that further research is needed to better explain socio-demographic differences reflected in the study results, adding these are a “considerable population health problem.”