Marriage improves heart attack outcomes

Living alone or being unmarried not only increases the risk of having a heart attack, but results in a worse prognosis after a heart attack in both men and women, according to researchers in Finland. Conversely, they say, especially among middle-aged couples, being married and cohabiting are associated with "considerably better prognosis of acute cardiac events both before hospitalization and after reaching the hospital alive."

The researchers claim that being unmarried or living alone “is known to increase total and cardiovascular mortality and cardiovascular disease incidence.” However, they note that many previous studies “included only men in their data and data on women and older age groups are missing or results are less consistent.”

The researchers studied the relation of sociodemographic characteristics to the morbidity, mortality, and case fatality (CF) of acute coronary syndrome (ACS) in a register of 15,330 cases of ACS among people aged 35 to 99 years in Finland from 1993 to 2002.

They found that ACS incidence and 28-day mortality rate were higher in unmarried men and women in all age groups. The prehospital CF of incident ACS was higher in single living and/or unmarried people aged 35 to 64 years. The 28-day CF was 26% (95% confidence interval [CI], 24–29%) in married men, 42% (95%, CI 37–47%) in men who had previously been married, and 51% (95%, CI 46–57%) in never-married men. Among women, the corresponding figures were 20% (95%, CI 15–24%), 32% (95%, CI 25–39%), and 43% (95%, CI 31–56%).

The researchers note that most of the excess mortality appeared before hospital admission and seemed not to be related to differences in treatment of ACS. The disparities in ACS morbidity and mortality by marital status tended to widen during the study period.