Unmarried patients with cardiovascular disease (CVD) are likely to die more quickly than their married counterparts, according to new research published in the Journal of the American Heart Association.

Previous research has suggested divorced individuals are at a higher risk of death in general, but studies evaluating marital status and cardiovascular outcomes are limited, wrote lead researcher Arshed Quyyumi, MD, a professor of medicine at Emory University in Atlanta, and colleagues.

Quyyumi and colleagues studied 6,051 patients undergoing cardiac catheterization for suspected or known coronary artery disease between 2003 and 2015. The study population averaged 63 years old and was 64 percent male.

Over a median follow-up of 3.7 years, the researchers found unmarried patients were 24 percent more likely to die from any cause, 45 percent more likely to die from CVD and had a 52 percent increased risk of cardiovascular death or myocardial infarction (MI).

The increased risk of cardiovascular death or MI was about 40 percent in patients who were never married or who were divorced or separated, but 71 percent in widowed individuals. The researchers said their study is the first to report adverse outcomes in separate unmarried groups.

“I was somewhat surprised by the magnitude of the influence of being married has (on heart patients),” Quyyumi said in a press release. “Social support provided by marriage, and perhaps many other benefits of companionship, are important for people with heart disease.”

The researchers pointed out married individuals may be more receptive to healthy lifestyle changes and more likely to be adherent to medication, although adherence wasn’t accounted for in the study’s database.

Marital status was captured by self-administered questionnaires, but the study didn’t consider cohabitation, which might have some of the same benefits as marriage for patients with CVD. In addition, the duration from divorce or widowhood to enrollment wasn’t evident. Finally, the authors cautioned their findings may not be generalizable to populations without CVD.

“Further investigation is needed to determine whether more aggressive treatment strategies can positively alter outcomes for unmarried patients,” they wrote.