Association Between Divorce and Risks for Acute Myocardial Infarction

Dupre, Matthew E.; George, Linda K.; Liu, Guangya; Peterson, Eric D.

doi:10.1161/circoutcomes.114.001291

Cited by 56 publications

(44 citation statements)

References 47 publications

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“…1,37–39 Numerous studies have also demonstrated that married adults have significantly lower rates of CVD and generally live longer with the disease than those who are not married. 40–42 In terms of socioeconomic background, studies have shown that adults with higher levels of socioeconomic status (i.e., more education and income) have lower rates of cardiovascular illness and better health outcomes than adults with lower levels of socioeconomic status. 11,43,44 Studies of psychosocial factors have been more limited; however, research has shown that adults who are depressed or lack social support are more likely to have CVD and experience adverse outcomes than adults with more favorable psychosocial attributes.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

Dupre

Nelson

Lynch

et al. 2017

The American Journal of the Medical Sciences

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Background Recent studies have drawn attention to nonclinical factors to better understand disparities in the development, treatment and prognosis of patients with cardiovascular disease. However, there has been limited research describing the nonclinical characteristics of patients hospitalized for cardiovascular care. Methods Data for this study come from 520 patients admitted to the Duke Heart Center from January 1, 2015 through January 10, 2017. Electronic medical records and a standardized survey administered before discharge were used to ascertain detailed information on patients’ demographic (age, sex, race, marital status and living arrangement), socioeconomic (education, employment and health insurance), psychosocial (health literacy, health self-efficacy, social support, stress and depressive symptoms) and behavioral (smoking, drinking and medication adherence) attributes. Results Study participants were of a median age of 65 years, predominantly male (61.4%), non-Hispanic white (67.1%), hospitalized for 5.11 days and comparable to all patients admitted during this period. Results from the survey showed significant heterogeneity among patients in their demographic, socioeconomic and behavioral characteristics. We also found that the patients’ levels of psychosocial risks and resources were significantly associated with many of these nonclinical characteristics. Patients who were older, women, nonwhite and unmarried had generally lower levels of health literacy, self-efficacy and social support, and higher levels of stress and depressive symptoms than their counterparts. Conclusions Patients hospitalized with cardiovascular disease have diverse nonclinical profiles that have important implications for targeting interventions. A better understanding of these characteristics will enhance the personalized delivery of care and improve outcomes in vulnerable patient groups.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

Dupre

Nelson

Lynch

et al. 2017

The American Journal of the Medical Sciences

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“…A robust literature links marital disruption (i.e., marital separation or divorce) to a range of poor health outcomes, including increased risk for all-cause mortality (Alviar et al, 2014; Dupre et al, 2015; Sbarra & Law, 2011; Shor et al, 2012). For example, in a long-term study of the Uppsala Birth Cohort, being divorced placed both men and women in the highest risk groups for early mortality, with a 46% and 27% higher relative mortality risk than their married counterparts, respectively (Donrovich et al, 2014).…”

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confidence: 99%

Marital disruption is associated with shorter salivary telomere length in a probability sample of older adults

Whisman

Robustelli

Sbarra

2016

Social Science & Medicine

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Rationale Marital disruption (i.e., marital separation, divorce) is associated with a wide range of poor mental and physical health outcomes, including increased risk for all-cause mortality. One biological intermediary that may help explain the association between marital disruption and poor health is accelerated cellular aging. Objective This study examines the association between marital disruption and salivary telomere length in a United States probability sample of adults ≥ 50 years of age. Method Participants were 3,526 individuals who participated in the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction (qPCR) on DNA extracted from saliva samples. Health and lifestyle factors, traumatic and stressful life events, and neuroticism were assessed via self-report. Linear regression analyses were conducted to examine the associations between predictor variables and salivary telomere length. Results Based on their marital status data in the 2006 wave, people who were separated or divorced had shorter salivary telomeres than people who were continuously married or had never been married, and the association between marital disruption and salivary telomere length was not moderated by gender or neuroticism. Furthermore, the association between marital disruption and salivary telomere length remained statistically significant after adjusting for demographic and socioeconomic variables, neuroticism, cigarette use, body mass, traumatic life events, and other stressful life events. Additionally, results revealed that currently married adults with a history of divorce evidenced shorter salivary telomeres than people who were continuously married or never married. Conclusion Accelerated cellular aging, as indexed by telomere shortening, may be one pathway through which marital disruption is associated with morbidity and mortality.

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“…We elected to compare results with the married/common-law patients living together group based on prior data suggesting this group had the lowest adjusted CV risk. 4,9,10,[15][16][17][18][19][20] We grouped patients who were separated, divorced, or widowed based on publications suggesting that this group was often at a higher risk for CV events. 9,[19][20][21][22][23][24] The primary outcome of this analysis was MACE 4 at 15 months, defined as a composite of all-cause death, repeat MI, stroke, or urgent coronary revascularization (UCR).…”

Section: Methodsmentioning

confidence: 99%

“…5,27 In an attempt to highlight the importance of life stressors on CV health, Dupre et al identified that an individual's current marital status was not associated with the incidence of MI, but rather changes in marital status, such as an accumulated number of divorces, were strongly associated with risk for MI. 4 Additionally, in a study analyzing MI patients of the MONICA/KORA data registry, it was observed that being married did not provide protective effects for CV events in patients post-MI. 10 However, it was found that in sexstratified groups, married patients with hyperlipidemia age < 60 years had reduced long-term all-cause mortality rates.…”

Section: Following Logistic Regression and Cox Proportional Hazarmentioning

confidence: 99%

Marital status and outcomes after myocardial infarction: Observations from the Canadian Observational Antiplatelet Study (COAPT)

Ghosh-Swaby

Tan

Bagai

et al. 2018

Clinical Cardiology

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While divorced or living alone, patients with stable cardiovascular disease are at increased risk for adverse cardiovascular events. The importance of marital status following a myocardial infarction (MI) is less clear. We hypothesized that marital status may affect cardiovascular outcomes following MI. We analyzed outcomes among patients with MI who underwent percutaneous coronary intervention from the Canadian Observational Antiplatelet Study (COAPT).Marital status was categorized into 3 groups: married/common-law patients living together; never married; and divorced, separated, or widowed patients. Patients were followed for 15 months and our primary outcome was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite of mortality, repeat acute MI, stroke, or urgent coronary revascularization. Multivariable logistic regression models were performed, with married/common-law patients living together considered the reference group. Among 2100 patients included in analyses, 1519 (72.3%) were married/common-law patients living together, 358 (17.1%) were separated/divorced/widowed, and 223 (10.6%) patients were never married.Dual antiplatelet therapy use after 15 months was similar across groups (75.4%, 77.8%, and 73.6%, respectively). The risk of MACE after 15 months was similar among married patients living together (12.7%; referent) compared with patients who were never married (13.9%; adjusted odds ratio: 1.09, 95% confidence interval: 0.58-2.07, P = 0.79) and patients separated/divorced/widowed (14.3%; adjusted odds ratio: 0.71, 95% confidence interval: 0.40-1.25, P = 0.23). Similarly, the risk of individual endpoints, including mortality, was similar across the 3 groups. Among patients stabilized following an MI, we found no association between marital status and 15-month outcomes.

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Association Between Divorce and Risks for Acute Myocardial Infarction

Cited by 56 publications

References 47 publications

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

Marital disruption is associated with shorter salivary telomere length in a probability sample of older adults

Marital status and outcomes after myocardial infarction: Observations from the Canadian Observational Antiplatelet Study (COAPT)

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