Unhappily married men 86% more likely to suffer sudden cardiac death

Men who are dissatisfied with their marriages are around 86 percent more likely to experience sudden cardiac death (SCD) than those who are very satisfied, according to research published in the Jan. 1 edition of the American Journal of Cardiology.

Lead author Nzechukwu M. Isiozor, MBBS, MScPH, and colleagues’ study focused on the relationship between marital satisfaction and SCD—a link that’s established but hasn’t been proven on a population level.

“Marital strain and hostility have been shown to cause an elevation in both systolic and diastolic blood pressures in some clinical studies,” Isiozor, of the University of Eastern Finland, and coauthors wrote. “Research has shown how good relation quality and satisfaction can lower the ambulatory blood pressure. There has been no previous investigation on the association between marriage satisfaction and SCD among the general population.”

The team studied data from 2,262 men enrolled in the Kuopio Ischemic Heart Disease study, an ongoing prospective population-based study in Finland. (It’s worth noting that in 2018, Finland was ranked the happiest country in the world). Participants were asked to fill out a questionnaire designed to assess their level of marital satisfaction on a four-point scale that ranged from “very satisfied” to “very dissatisfied.”

Men involved in the study were, on average, in their 50s, and were followed up with for a median of 26 years. During that time, the research team recorded 239 SCDs. After adjusting for a host of conventional cardiovascular risk factors, Isiozor et al. found that, compared with men who were very satisfied with their marriages, those who were dissatisfied saw an 86 percent higher risk of SCD.

Considering that “an element of dissatisfaction can exist in a ‘fairly satisfied’ marriage,” the authors combined results from their “fairly satisfied” and “dissatisfied” cohorts for a more realistic risk assessment. In that case, they found a 43 percent increased risk of SCD in men dissatisfied with their relationships.

Isiozor and coauthors attributed their findings to several potential factors including the increased stress that can come with an unhappy marriage, which triggers the autonomic nervous system and causes the release of catecholamines with a resultant increase in heart rate, decrease in heart rate variability and elevation in core body temperature.

In an editorial linked to Isiozor et al.’s work, a group of physicians headed by Roberto Manfredini, MD, said the team’s findings are in line with those of previous studies, which have carved out a strong relationship between marital instability and poor cardiovascular health.

“Many positive items could be related, in general, to being married versus loneliness,” Manfredini and colleagues wrote. “Healthier meals, better sleep, less stress, financial benefits, better mood. It is possible that persons who are married may have lower mortality because of protective effects of marriage or even selection of healthy individuals into marriage. In fact, people who have a spouse exhibit higher compliance with medical controls, medications and screening programs.”

Asking men about their relationship satisfaction, then, could be a helpful clinical tool to identify patients who might need increased support to stay healthy.

“For CV disease, on one hand being married seems to be better than being unmarried,” Manfredini et al. said. “On the other, being married but with bad quality of satisfaction exposes to the highest risk of poor outcome. In both cases, men are more affected.”