Approximately 800,000 adults suffer a stroke each year, making the condition a leading cause of death in the U.S. Research has shown that patients benefit from adhering to their medications and reducing risk factors such as smoking and obesity.

A recent study suggests they may also survive longer after a stroke if they remain married.

The researchers, who published their findings in the Journal of the American Heart Association on Dec. 14, said the study was the first prospective investigation of how marital history was related to survival after stroke in the U.S.

They collected data on 2,351 adults who suffered a stroke and were at least 50 years old. The participants answered questions about their marital history and whether they were single, married, widowed or divorced.

Adults who had no marital loss and were continuously married were significantly more likely to survive after a stroke compared with those who were widowed or divorced.

One model found that compared with adults who remained continuously married, those who never married had a 71 percent increased risk of death, those who remarried had a 23 percent increased risk of death, those who divorced had a 23 percent increased risk of death and those who were widowed had a 25 percent increased risk of death.

Another model found that participants who had two or more marital losses had a 41 percent increased risk of death even after accounting for differences in age at onset, sex, race, ethnicity, proxy interview and geographic region.

The findings were similar between men and women and did not differ by race or ethnicity.

“Previous studies have shown associations between marital status and multiple health outcomes,” the researchers wrote. “The current study builds on this literature and is the first to demonstrate an association between marital history and prospective survival after the onset of a stroke.”

The observational study was not powered to identify reasons for the association between marriage and lower risk of death following stroke and the results did not indicate causality.

The researchers suggested that biological mechanisms such as blood pressure reactivity, elevated cortisol or hemoglobin A1c related to marital loss could have played a role. They also mentioned that marital dissolution could have affected medication adherence and healthcare utilization.

“More research is needed to know the full clinical implications of our findings,” Matthew E. Dupre, PhD, the lead researcher from the Duke Clinical Research Institute, said in a news release. “Greater knowledge about the risks associated with marital life and marital loss may be useful for personalizing care and improving outcomes for those who are recovering from a stroke.”