Married people are less likely to die from a heart attack than their single counterparts, a new study found.
The Finnish study found men and women were twice as likely to die after an acute coronary sydnrome event such as a heart attack if they were unmarried. Unmarried people also had higher rates of ACS, with the disparity increasing over the 15-year study period.
"Our study suggests that marriage reduces the risk of ACS and death due to ACS in both men and women and at all ages," Dr. Aino Lammintausta of Turku University Hospital in Turka, Finland, and co-authors reported online in the European Journal of Preventive Cardiology. "Furthermore, especially among middle-age men and women, being married and cohabiting are associated with considerably better prognosis of incident ACS events, both before hospitalization and after reaching the hospital alive.
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"Marriage seems to protect women even more than men from out-of-hospital death," the authors added. "The differences in prognosis cannot fully be explained by differences in treatment-seeking time or access to thrombolysis or revascularization."
Multiple studies have shown that unmarried people and those living alone have a heightened risk of cardiovascular disease and associated mortality. Most of the studies have focused on middle-age men and provided little information about women or older adults, the authors noted in their introduction.
Moreover, some of the studies were conducted 30 to 40 years ago and might no longer be relevant, given the increasing population of unmarried persons.
To examine the current impact of marital status on ACS outcomes, Lammintausta and colleagues analyzed data from a Finnish registry of patients with suspected myocardial infarction during 1993 to 2002. They determined trends in event rates for men and women ages 35 and older.
During the study period, the registry accumulated 15,330 ACS events, including 9,646 first events and 7,703 fatal events. Men accounted for 8,137 (53 percent) events and women for 7,193 (47 percent) events.
The authors found that 3,005 events occurred in unmarried men, and that 70 percent of those events involved men who had been married previously. Unmarried women accounted for 5,410 (75 percent) of all events in women, and 84 percent of the events involved previously married women.
Across age groups, the age-standardized incidence of ACS events was 58 percent to 66 percent higher among unmarried and 60 percent to 65 percent higher in unmarried women compared with married men and women.
An even greater marital-status disparity emerged for 28-day mortality associated with ACS: 60 percent to 168 percent higher in unmarried men and 71 percent to 175 percent higher in unmarried women.
Rates did not differ significantly between previously married and never married individuals.
Across all age groups and both sexes, ACS events were significantly more frequent among unmarried people before hospital admission, on the first day after admission, and 28 days after the event. The case-fatality rate also was significantly higher at all time points among unmarried men and women.
Aside from a difference in thrombolysis -- married men received it more often than unmarried men -- treatment variation did not account for the difference in ACS incidence or mortality.
Overall, the ACS incidence, event rates, and 28-day mortality decreased over time with one exception: Never-married women had rising rates of ACS and events compared with married women.