Marital Status and Outcomes in Patients With Cardiovascular Disease
BackgroundBeing unmarried is associated with decreased survival in the general population. Whether married, divorced, separated, widowed, or never‐married status affects outcomes in patients with cardiovascular disease has not been well characterized. Methods and ResultsA prospective cohort (incepti...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.005890 |
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| author | William M. Schultz Salim S. Hayek Ayman Samman Tahhan Yi‐An Ko Pratik Sandesara Mosaab Awad Kareem H. Mohammed Keyur Patel Michael Yuan Shuai Zheng Matthew L. Topel Joy Hartsfield Ravila Bhimani Tina Varghese Jonathan H. Kim Leslee Shaw Peter Wilson Viola Vaccarino Arshed A. Quyyumi |
| author_facet | William M. Schultz Salim S. Hayek Ayman Samman Tahhan Yi‐An Ko Pratik Sandesara Mosaab Awad Kareem H. Mohammed Keyur Patel Michael Yuan Shuai Zheng Matthew L. Topel Joy Hartsfield Ravila Bhimani Tina Varghese Jonathan H. Kim Leslee Shaw Peter Wilson Viola Vaccarino Arshed A. Quyyumi |
| author_sort | William M. Schultz |
| collection | DOAJ |
| description | BackgroundBeing unmarried is associated with decreased survival in the general population. Whether married, divorced, separated, widowed, or never‐married status affects outcomes in patients with cardiovascular disease has not been well characterized. Methods and ResultsA prospective cohort (inception period 2003–2015) of 6051 patients (mean age 63 years, 64% male, 23% black) undergoing cardiac catheterization for suspected or confirmed coronary artery disease was followed for a median of 3.7 years (interquartile range: 1.7–6.7 years). Marital status was stratified as married (n=4088) versus unmarried (n=1963), which included those who were never married (n=451), divorced or separated (n=842), or widowed (n=670). The relationship between marital status and primary outcome of cardiovascular death and myocardial infarction was examined using Cox regression models adjusted for clinical characteristics. There were 1085 (18%) deaths from all causes, 688 (11%) cardiovascular‐related deaths, and 272 (4.5%) incident myocardial infarction events. Compared with married participants, being unmarried was associated with higher risk of all‐cause mortality (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.06–1.47), cardiovascular death (HR: 1.45; 95% CI, 1.18–1.78), and cardiovascular death or myocardial infarction (HR: 1.52; 95% CI, 1.27–1.83). Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated (HR: 1.41; 95% CI, 1.10–1.81), widowed (HR: 1.71; 95% CI, 1.32–2.20), or never married (HR: 1.40; 95% CI, 0.97–2.03). The findings persisted after adjustment for medications and other socioeconomic factors. ConclusionsMarital status is independently associated with cardiovascular outcomes in patients with or at high risk of cardiovascular disease, with higher mortality in the unmarried population. The mechanisms responsible for this increased risk require further study. |
| first_indexed | 2024-12-22T21:40:47Z |
| format | Article |
| id | doaj.art-4dea50332efa428ea3efab2ad232dce0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:40:47Z |
| publishDate | 2017-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4dea50332efa428ea3efab2ad232dce02022-12-21T18:11:37ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-12-0161210.1161/JAHA.117.005890Marital Status and Outcomes in Patients With Cardiovascular DiseaseWilliam M. Schultz0Salim S. Hayek1Ayman Samman Tahhan2Yi‐An Ko3Pratik Sandesara4Mosaab Awad5Kareem H. Mohammed6Keyur Patel7Michael Yuan8Shuai Zheng9Matthew L. Topel10Joy Hartsfield11Ravila Bhimani12Tina Varghese13Jonathan H. Kim14Leslee Shaw15Peter Wilson16Viola Vaccarino17Arshed A. Quyyumi18Department of Medicine, Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADepartment of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GADepartment of Biomedical Informatics, Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADepartment of Medicine, Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GADivision of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GABackgroundBeing unmarried is associated with decreased survival in the general population. Whether married, divorced, separated, widowed, or never‐married status affects outcomes in patients with cardiovascular disease has not been well characterized. Methods and ResultsA prospective cohort (inception period 2003–2015) of 6051 patients (mean age 63 years, 64% male, 23% black) undergoing cardiac catheterization for suspected or confirmed coronary artery disease was followed for a median of 3.7 years (interquartile range: 1.7–6.7 years). Marital status was stratified as married (n=4088) versus unmarried (n=1963), which included those who were never married (n=451), divorced or separated (n=842), or widowed (n=670). The relationship between marital status and primary outcome of cardiovascular death and myocardial infarction was examined using Cox regression models adjusted for clinical characteristics. There were 1085 (18%) deaths from all causes, 688 (11%) cardiovascular‐related deaths, and 272 (4.5%) incident myocardial infarction events. Compared with married participants, being unmarried was associated with higher risk of all‐cause mortality (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.06–1.47), cardiovascular death (HR: 1.45; 95% CI, 1.18–1.78), and cardiovascular death or myocardial infarction (HR: 1.52; 95% CI, 1.27–1.83). Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated (HR: 1.41; 95% CI, 1.10–1.81), widowed (HR: 1.71; 95% CI, 1.32–2.20), or never married (HR: 1.40; 95% CI, 0.97–2.03). The findings persisted after adjustment for medications and other socioeconomic factors. ConclusionsMarital status is independently associated with cardiovascular outcomes in patients with or at high risk of cardiovascular disease, with higher mortality in the unmarried population. The mechanisms responsible for this increased risk require further study.https://www.ahajournals.org/doi/10.1161/JAHA.117.005890cardiovascular diseasedivorcemarital statusmortalitynever marriedsocioeconomic position |
| spellingShingle | William M. Schultz Salim S. Hayek Ayman Samman Tahhan Yi‐An Ko Pratik Sandesara Mosaab Awad Kareem H. Mohammed Keyur Patel Michael Yuan Shuai Zheng Matthew L. Topel Joy Hartsfield Ravila Bhimani Tina Varghese Jonathan H. Kim Leslee Shaw Peter Wilson Viola Vaccarino Arshed A. Quyyumi Marital Status and Outcomes in Patients With Cardiovascular Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular disease divorce marital status mortality never married socioeconomic position |
| title | Marital Status and Outcomes in Patients With Cardiovascular Disease |
| title_full | Marital Status and Outcomes in Patients With Cardiovascular Disease |
| title_fullStr | Marital Status and Outcomes in Patients With Cardiovascular Disease |
| title_full_unstemmed | Marital Status and Outcomes in Patients With Cardiovascular Disease |
| title_short | Marital Status and Outcomes in Patients With Cardiovascular Disease |
| title_sort | marital status and outcomes in patients with cardiovascular disease |
| topic | cardiovascular disease divorce marital status mortality never married socioeconomic position |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.005890 |
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