Ooi SL Amy, See KS Kris, Osel Clinic, Osel Group
Abstract: Marriage. Definition of marriage is the legally or formally recognized union of two people as partners in a personal relationship (historically and in some jurisdictions specifically a union between a man and a woman)[1]. Marriage is a legally recognized union between two partners in a relationship. The average age to first get married varies from one country to another and is affected by several factors such as financial stability, career, academic pursuit, and family background.[2] There is evidence showing that marital status (MS) and marital disruption (i.e., separation, divorce, and being widowed) are associated with poor physical health outcomes, including for all-cause mortality.
Previous studies observed that, in hospitalized subjects, marital status (MS) represented independent risk factor for some important outcomes.[2] In fact, admission severity of illness was higher in unmarried than married patients, and moderate or high severity was significantly different from unmarried and married patients (40% vs. 32%, respectively). Moreover, the results from a study conducted in the United States showed that current marriage was associated with longer survival. Independent of demographic and socioeconomic characteristics, the death rate for unmarried subjects was significantly higher than for married subjects. Although the effect was significant for all categories of unmarried persons, it was greatest for those who had never married and significantly stronger for men than for women.[3]
Cardiovascular Disease
Cardiovascular disease(CVD) is a class of diseases that involve the heart or blood vessels.[4]Cardiovascular disease includes coronary artery diseases (CAD) such as angina and myocardia infarction (commonly known as a heart attack). Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, heart arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.[4]
Cardiovascular disease (CVD) is associated with significant morbidity and mortality.[5] In order to reduce the burden of CVD, there is great interest in identifying risk factors in the general population so that those deemed to be at high risk for future cardiovascular events can be targeted for intervention. While 80% of the risk for future CVD can be predicted from known cardiovascular risk factors such as old age, male sex, hypertension, hyperlipidaemia, smoking and diabetes mellitus, the determinants for the remaining 20% risk remain unclear.[5]
Researches
In Emory University, School of Medicine, Atlanta GA, prospective cohort (inception period 2003–2015) of 6051 patients undergoing cardiac catheterization for suspected or confirmed coronary artery disease. Marital status was stratified as married (n=4088) versus unmarried (n=1963), which included those who were never married (n=451), divorced or separated (n=842), or widowed (n=670). Compared with married participants, being unmarried was associated with higher risk of all‐cause mortality (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.06–1.47), cardiovascular death (HR: 1.45; 95% CI, 1.18–1.78), and cardiovascular death or myocardial infarction (HR: 1.52; 95% CI, 1.27–1.83). Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated (HR: 1.41; 95% CI, 1.10–1.81), widowed (HR: 1.71; 95% CI, 1.32–2.20), or never married (HR: 1.40; 95% CI, 0.97–2.03). The findings persisted after adjustment for medications and other socioeconomic factors.[6]
Another analysis done by the ASPIRE Summer Studentship programme at Keele University in January 2018, 34 studies with more than two million participants. Compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42; 95% CI 1.00 to 2.01), CHD (OR 1.16,95% CI 1.04 to 1.28), coronary heart disease death (OR 1.43,95% CI 1.28 to 1.60) and stroke death (OR 1.55,95% 1.16 to 2.08). Being divorced was associated with increased odds of CHD (P<0.001) for both men and women while widowers were more likely to develop a stroke (P<0.001). Single men and women with myocardial infarction had increased mortality (OR 1.42, 95% CI 1.14 to 1.76) compared with married participants. [7]
Conclusion
Unmarried patients with known or suspected CVD have an increased risk of all cause and cardiovascular mortality compared with married individuals, even after extensive adjustment for differences in demographic and cardiovascular risk factors. The risk of adverse outcomes was attenuated with age. Accounting for unmarried status in the management of patients with CVD, consideration of associated psychological conditions, and potentially more aggressive follow-up and therapy need to be considered in future studies.[6]These findings may also suggest that marital status should be considered in the risk assessment for CVD and outcomes of CVD based on marital status merits further investigation.[7]
References
1. "The Nations Of Europe By The Average Age At First Marriage". WorldAtlas. Retrieved 2018-04-10.
2. Gordon HS, Rosenthal GE. Impact of marital status on outcomes in hospitalized patients. Evidence from an academic medical centre.Arch Intern Med 1995;155:2465–2471.
3. Kaplan RM, Kronick RG. Marital status and longevity in the United States population. J Epidemiol Community Health 2006:60:760–765
4.WHO.Cardiovasculardiseases(CVDs).2018.http://www.who.int/mediacentre/factsheets/fs317/en/Xie G, Zou H, Myint PK, et al. Baseline overall health-related quality of life predicts the 10-year incidence of cardiovascular events in Chinese population. Qual Life Res2016;25:3633-71
6. William M.S, et al. Marital Status And Outcome In Patients With Cardiovascular Disease. Journal of the American Heart Association. December 2017
7. C.W. Wong, et al. Marital Status and Risk of Cardiovascular Disease: A Systemic review and Meta-Analysis. Heart 2018; - Published Online First: 18 Jun 2018. doi: 10.1136/heartjnl-2018-313469
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