Few phrases may seem as romantic as “’til death do we part.” But could parting bring people closer to death?
In a new study published Wednesday in the Journal of the American Heart Association, researchers at Emory University in Atlanta found that people with cardiovascular disease who were not married –- including those who were divorced, separated, widowed or never married –- had 24 percent higher rates of death from any cause during the study period, compared to those who were married.
Specifically, not being married was associated with a higher risk of death from cardiovascular causes, like heart attacks and strokes, for the more than 6,000 Emory Healthcare patients in this study. Divorced and separated people had a 41 percent increased risk of death; widowed people had nearly double that risk.
"I was somewhat surprised at the impact," Dr. Arshed Quyyumi, the study’s lead researcher and co-director of Emory Clinical Cardiovascular Research Institute, told ABC News. “But we suspected there might be something, since there have been studies that signal that marital status affects how well people do.”
This was a large study conducted between 2003 and 2015 that included 50 to 70 year old participants, from diverse racial groups, who had cardiovascular disease -- including coronary artery disease, heart failure and previous heart attacks. Each participant was followed for an average of 3.7 years.
Even after accounting for known cardiac risk factors -- such as diabetes and smoking, different types of heart disease, socioeconomic background, age, sex and appropriate treatment –- being unmarried still showed higher risk of death for these patients.
One expert not involved with the research agreed that the findings offer additional clues to the importance of relationships when it comes to health.
“This study adds to this line of research,” Dr. Matthew Dupre, an associate professor at Duke University who has done extensive research on social factors and heart outcomes, told ABC News.
“There is now a growing body of work showing how our social relationships, particularly the disruption of these relationships through divorce or widowhood, can get under our skin and have immediate and lasting consequences for our cardiovascular health.”
For this study, the researchers did not specifically look for why these differences exist. But the research team, as well as Dupre, note that previous research suggests less social support, stress from divorce or a spouse passing and less motivation to have a healthy lifestyle, or to stick to medical treatment, may play a role.
“All these things can be put under the basket of social support,” study author Quyyumi said. “Cardiovascular disease, even though we consider diabetes and high cholesterol to be high risk factors, it is sizably impacted by psychosocial status –- how stressed you are, how depressed you are. Being alone, lonely, etc. may well do the same.”
For people who are widowed or getting divorced, there may be other stressors that can lead to worse heart health.
“After the depression and grieving, be alerted to the fact that your life is altered and don’t fall into high risk behaviors. Perhaps, create a social network,” Quyyumi said. “All those things become important.”
The researchers did not account for people who changed their marriage status during the study, but Quyyumi explained that would not likely affect the results because only a small amount of people in their sixties change marital status over the course of two to seven years. The study also did not specifically account for people who have partners, but are not married.
“I wouldn’t say that if you have heart disease, you have to get married. I’m not sure anyone has prescribed getting married to prevent getting sicker,” Quyyumi said. “But I think doctors and even family and friends can pay more attention when life events occur –- perhaps these people need extra care and attention to compensate for things they are now missing.”
More research is needed to further study how different relationship statuses affect those with heart disease –- and possible ways to help those who might be more vulnerable.