Nov. 2, 2022 -- Being less stressed in general is linked to better heart health. Now, a large study shows that having a less stressful, happier marriage is associated with better recovery in people who have a heart attack at a relatively young age — less than 55.
Researchers found that those who had the most stressful marriages were more likely to have more frequent chest pain or be readmitted to hospital in the year following their heart attack.
People with a stressful marriage had a worse recovery after a heart attack compared to other heart attack survivors of the same age, sex, education, and income level, as well as employment and insurance status, their study found.
"I would tell young cardiac patients that stress in their marriage or partnered relationship may adversely affect their recovery after a heart attack," says Cenjing Zhu, a PhD candidate at the Yale School of Public Health in New Haven, CT. "Managing personal stress may be as important as managing other clinical risk factors" such as blood pressure, for example, "during the recovery process."
General advice for everyone is to be aware of whether you have common risk factors for heart disease including high blood pressure, high cholesterol, diabetes, obesity, or smoking, and for younger people to be aware of a family history of heart disease, particularly premature heart disease, Zhu says.
"Patients should know there is a link between marital stress and delayed recovery" from heart attack, says AHA spokesperson Nieca Goldberg, MD, who was not involved with this research.
"If they have marital stress, they should share the information with their doctor and discuss ways to get a referral to therapists and cardiac rehabilitation," says Goldberg, a clinical associate professor of medicine at NYU Grossman School of Medicine and medical director of Atria New York City.
"My final thought is women have often been told [by doctors] that their cardiac symptoms are due to stress," she says. "Now we know stress impacts physical health and is no longer an excuse but a contributing factor to our physical health."
A lot of studies have reported that psychological stress is linked with worse heart health outcomes, Zhu says.
However, little was known about the effect of a stressful marriage on younger survivors of a heart attack.
The researchers analyzed data from participants in a study known as Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO).
This included 1,593 adults — 1,020 women — who were treated at 103 hospitals in 30 U.S. states. Most of these heart attack survivors were married and 8% were living as married/living with a partner.
Most (90%) were age 40 to 55, and the rest were younger. Their average age was 47. Three-quarters were white, 13% were Black, and 7% were Latino.
A month after their heart attack, they replied to 17 questions in the Stockholm Marital Stress Scale about the quality of their emotional and sexual relationships with their spouses/partners. Then 1 year after their heart attack, the patients replied to several questionnaires about their health.
A year later, those who reported severe marital stress had significantly worse scores for physical health, mental health, general quality of life, and quality of life related to their heart health, compared to the patients with no or mild marital stress.
The heart attack survivors with the most marital stress were 49% more likely to report more frequent chest pain/angina and 45% more likely to have been readmitted to hospital for any cause, compared to the patients with no or mild marital stress.
Study limitations include that the findings are based on a self-reported questionnaire.
"Additional stressors beyond marital stress, such as financial strain or work stress, may also play a role in young adults' recovery, and the interaction between these factors require further research," Zhu says.
The researchers will present their findings at the American Heart Association (AHA) 2022 Scientific Sessions, being held in Chicago this weekend.