Marital status and ischemic heart disease incidence and mortality in women: a large prospective study

Abstract

Background: Being married has been associated with a lower mortality from ischemic heart disease (IHD) in men, but there is less evidence of an association for women, and it is unclear whether the associations with being married are similar for incident and for fatal IHD. We examined the relation between marital status and IHD incidence and mortality in the Million Women Study.

Methods: A total of 734,626 women (mean age 60 years) without previous heart disease, stroke or cancer, were followed prospectively for hospital admissions and deaths. Adjusted relative risks (RRs) for IHD were calculated using Cox regression in women who were married or living with a partner versus women who were not. The role of 14 socio-economic, lifestyle and other potential confounding factors was investigated.

Results: 81% of women reported being married or living with a partner and they were less likely to live in deprived areas, to smoke or be physically inactive, but had a higher alcohol intake than women who were not married or living with a partner. During 8.8 years of follow-up, 30,747 women had a first IHD event (hospital admission or death) and 2,148 died from IHD. Women who were married or living with a partner had a similar risk of a first IHD event as women who were not (RR = 0.99, 95% confidence interval (CI) 0.96 to 1.02), but a significantly lower risk of IHD mortality (RR = 0.72, 95% CI 0.66 to 0.80, P <0.0001). This lower risk of IHD death was evident both in women with and without a prior IHD hospital admission (respectively: RR = 0.72, 95% CI 0.60 to 0.85, P <0.0001, n = 683; and 0.70, 95% CI 0.62 to 0.78, P <0.0001, n = 1,465). These findings did not vary appreciably between women of different socio-economic groups or by lifestyle and other factors.

Conclusions: After adjustment for socioeconomic, lifestyle and other factors, women who were married or living with a partner had a similar risk of developing IHD but a substantially lower IHD mortality compared to women who were not married or living with a partner.

Figure 1

Relative risk of ischemic heart disease first event and mortality in relation to marital status. Relative risks (RRs) presented with 95% confidence intervals (95% CI). Fully adjusted for: age, region, area deprivation, age left school, highest educational qualification, smoking, alcohol intake, strenuous exercise, body mass index, hormone replacement therapy use, sleep duration, happiness, treatment for depression, parity, employment and participation in group activities. IHD, ischemic heart disease.

Figure 2

Relative risk of ischemic heart disease first event and mortality by marital status, in subgroups. Relative risks (RRs) presented with 95% confidence intervals (95% CI). The dotted line represents the RR of IHD mortality for all women, comparing partnered to unpartnered. RRs are adjusted as appropriate for age, region, area deprivation, age left school, highest educational qualification, smoking, alcohol intake, strenuous exercise, body mass index, hormone replacement therapy use, sleep duration, happiness, treatment for depression, parity, employment and participation in group activities. IHD, ischemic heart disease.