Marriage improves ACS prognosis—especially for men

A study published in the Journal of the American Heart Association this month identified marriage as a predictor of better short- and long-term outcomes in patients with acute coronary syndromes (ACS), most notably male patients.

Though daily clinical practice focuses more on the physical side of things—like biological risk factors for coronary artery disease—we know psychosocial parameters can have a significant influence on heart health, first author Gil Marcus, MD, and colleagues wrote in JAHA. In one study, spouses who reported improving their marriages lost an average of 10 pounds over six years; in another, unhappily married men were 86% more likely than their counterparts to experience sudden cardiac death.

“Most of the existing data emerging from studies include stable patients undergoing percutaneous coronary artery intervention, those undergoing coronary artery bypass surgery or patients with acute myocardial infarction,” Marcus, of Assaf-Harofeh Medical Center in Zerifin, Israel, and co-authors said. “The impact of marriage on the outcome of patients along the full spectrum of ACS is less robust.”

Marcus and his team pulled data from the ACS Israeli Survey, collected between 2004 and 2016, to compare the baseline characteristics and outcomes of married patients with ACS to the outcomes of unmarried patients with the same indication. Of 7,233 participants, 5,642—78% of the group—reported being married, and those patients tended to be younger and were less often hypertensive.

Just over half of women in the study were married, and 83% of men reported the same. All-cause mortality incidence at 30 days and one year was lower in married patients—3.1% and 7.6% in married subjects compared to 7.1% and 15.3% in unmarried subjects. After adjusting for covariates, Marcus et al. concluded married patients were 26% less likely to die from any cause in the five years following their ACS diagnosis compared to unmarried patients.

The authors identified a sex difference in their findings, too. They said married men had the best long-term prognosis for ACS, while unmarried women saw the worst long-term prognosis. Marriage seemed to be protective in both the short- and long-term for all patients.

“These disparities might result from a higher incidence of depression among women, especially if non-married,” Marcus and co-authors wrote. “Other social explanations for these differences include the fact that women had a longer delay in seeking care, they were less likely to involve their spouses in the recovery process and, in general, they were believed to have less support and lack of belief in their cardiac conditions.”

The team said their work was limited in that patients self-reported data about their marital status, subjecting the research to bias. Marcus et al. also included all unmarried patients in a singular group when, in reality, they likely have varying characteristics that should be explored in a separate study.

“This study adds to the accumulated knowledge highlighting the association between marital status and outcomes after ACS,” the authors wrote. “Because marital status can be viewed as a risk-stratifying index, it is suggested that caregivers focus on secondary prevention measures in the non-married patients, especially non-married women, probably reflecting a more vulnerable population.”