Marriage may protect against developing heart disease or having a stroke, according to a global study led by Keele University and the University of Arizona College of Medicine – Phoenix. 

The findings, from a pooled analysis of available data and published online in the journal Heart, suggest that marital status should be included as a risk factor for heart disease and stroke.

“Marital status appears to be a risk factor for heart disease and stroke, and should be assessed when assessing cardiovascular risk,” said Martha Gulati, MD, MS, FACC, FAHA, chair of the Department of Cardiology at the University of Arizona College of Medicine – Phoenix, a co-author of the study. “Marital status also may reflect other risk factors for heart disease, including socioeconomic status, social support, depression, poor diet and other adverse health behaviors.”

Those who were divorced, widowed or never married had a 42 percent greater risk of developing cardiovascular disease and a 16 percent greater risk of developing coronary artery heart disease compared with people who were married.

Eighty percent of cardiovascular disease can be attributed to well-known risk factors such as age, sex, high blood pressure, high cholesterol, smoking and diabetes. It’s not clear what influences the remaining 20 percent.

The research was led by Keele University in collaboration with the University of Arizona College of Medicine – Phoenix and four other universities in Australia, Saudi Arabia and England.

“Our work suggests that marital status should be considered in patients with or at risk of developing cardiovascular disease, and should be used alongside more traditional cardiac risk factors to identify those patients that may be at higher risk for future cardiovascular events,” said Mamas Mamas, the study’s senior author and professor at Keele University in England.

Previous research on the impact of marital status has been mixed, so in a bid to clarify the issues, the authors drew on 34 studies published between 1963 and 2015 that involved more than 2 million people between the ages of 42 and 77 from North America, Europe, Scandinavia, the Middle East and Asia.

There are various theories as to why marriage may be protective, including earlier recognition of and response to health problems, better adherence to medication, better financial security and better friendship networks.

Researchers said the most important message to physicians is to evaluate patients’ social circumstances, including marital status, and consider the need for additional support as part of a holistic approach. 

While there was no difference in the risk of death following a stroke between the married and the unmarried, this was not the case after a heart attack, the risk of which was significantly higher (42 percent) among those who had never married. 

The authors caution that the methods used and adjustments made for potentially influential factors varied considerably across all the studies, which may have affected the results of their analysis. Similarly, there was no information on same sex partnerships or the quality of marriage, and the potential role of living with someone, as opposed to being married to them, was not explored. But this is the largest study to date, with the age and ethnicity of the participants strengthening the wider applicability of the findings, the authors point out.

“Future research should focus around whether marital status is a surrogate marker for other adverse health behavior or cardiovascular risk profiles that underlies our reported findings or whether marital status should be considered as a risk factor by itself,” the authors concluded.