Marriage Dissatisfaction and the Risk of Sudden Cardiac Death Among Men

doi:10.1016/j.amjcard.2018.09.033

The American Journal of Cardiology

Volume 123, Issue 1, 1 January 2019, Pages 7-11

https://doi.org/10.1016/j.amjcard.2018.09.033 Get rights and content

Conflicts in marriage have been associated with potential risk of cardiovascular disease; however, there is lack of prospective evidence on the association between marriage satisfaction and sudden cardiac death (SCD). We aimed to assess the association between perceived level of marriage satisfaction and risk of SCD. This study employed the Kuopio Ischemic Heart Disease study, an ongoing prospective population-based study in Finland. Perceived level of marriage satisfaction was assessed in 2,262 men using a well-structured self-administered questionnaire. Multivariable adjusted Cox regression models were used to estimate hazard ratios (95% confidence interval [CI]) for SCD. During a median follow-up period of 25.9 years, 239 SCDs were recorded. The mean age of participants was 53 (SD 5.2) years. On adjustment for several conventional cardiovascular risk factors, hazard ratio (95% CI) of SCD was 1.90 (CI 1.09 to 3.32; p = 0.02) for men who were dissatisfied with their marriage, compared with men who were satisfied with their marriage. The association remained consistent on further adjustment for preexisting coronary heart disease, socioeconomic status, and years of education 1.86 (CI 1.07 to 3.25; p = 0.03). In conclusion, dissatisfied marriage is associated with an increased risk of SCD among middle-aged Caucasian men, independent of conventional cardiovascular risk factors.

Section snippets

Methods

This study employed the Kuopio Ischemic Heart Disease (KIHD) study, which is an ongoing prospective population-based study. The KIHD was designed to investigate the different risk factors for developing CVDs and other chronic diseases among middle-aged and aging men and women in Kuopio and the surrounding communities in eastern Finland.⁷ The study started in 1984 with the baseline sample of 3,433 men aged 42 to 60 years, who were randomly selected from the national population register. At

Results

Table 1 lists the baseline characteristics of 2,262 participants. The mean age of the men at recruitment was 53 years (SD 5.2). A total of 239 cases of SCD were reported within the median follow-up period of 25.9 (IQR 18.9 to 28.0) years. An overview of the characteristics of the participants showed that men that were fairly satisfied with their marriages accounted for the highest percentage (55.2%).

Table 2 reports the association between perceived marriage satisfaction and the risk of SCD. In

Discussion

In this population-based cohort study, the relation between marriage satisfaction and risk of SCD was determined among Caucasian men. Compared with a very satisfied marriage, perceived dissatisfaction in marriage was associated with an increased risk of SCD among men, and this was independent of several conventional and emerging risk factors. Similarly, even a fairly satisfied marriage was also related to a higher risk of SCD, compared with those who were very satisfied of their marriage. These

Disclosures

The authors have no conflicts of interest to disclose.

Acknowledgment

The authors thank the staff of the Kuopio Research Institute of Exercise Medicine and the Research Institute of Public Health and University of Eastern Finland, Kuopio, Finland, for the data collection in the study.

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Citation Excerpt :
Our second objective was to investigate how the association varied across different BMI categories. We used population-based data from the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study in eastern Finland, comprising men aged 42–60 years at baseline [18]. The KIHD study was designed to investigate risk factors for developing CVD and other chronic diseases among middle-aged and older men and women living in Kuopio and the surrounding communities in eastern Finland [19].
Copper (Cu) is a component of enzymes catalyzing oxidation-reduction reactions. With the persisting burden of cardiovascular disease (CVD), there is evident need to identify biomarkers and potential risk factors for CVD. We therefore examined the association between serum Cu levels and the risk of CVD death in Finnish men and across different body mass index (BMI) categories.
This Finnish prospective study is based on 1911 men aged 42–60 years who were free of coronary heart disease at baseline. Cu concentrations (mg/l) were determined using atomic absorption spectrometer and categorized into quartiles (<1.0; 1 to <1.1; 1.1 to <1.21; ≥1.21). Participants were categorized into normal weight <25 kg/m², pre-obesity 25–29.9 kg/m², and obesity >30 kg/m². The association between Cu and CVD death was analyzed using multivariable Cox regression models. During a median follow-up of 25.8 years, 358 CVD deaths occurred. The risk of CVD death increased continuously with increasing Cu levels (for non-linearity, p = 0.64). Using the first quartile as reference after adjustment for covariates, the hazard ratios (HR) (95% confidence interval (CI)) for CVD death for Cu concentrations in second, third and fourth quartiles were 1.45(1.05–2.01), 1.69(1.25–2.27), and 1.68(1.23–2.29), respectively. Obese men in the third quartile of serum Cu concentrations had highest risk of CVD death (HR (95%CI) 2.71(1.27–5.78)).
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Also, NHANES lacks information on cohabitation/living with someone, which is associated with a protective effect,29 thus can introduce bias, with results in negative association with QT interval in unmarried subgroups. Among married, we also lack data on marriage dissatisfaction, which can negatively affect the health of participants.30 The strength of our study includes large sample size, community-based multiracial population, and well-ascertained variables including ECG data evaluated at a central reading center.
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View full text

Marriage Dissatisfaction and the Risk of Sudden Cardiac Death Among Men

Section snippets

Methods

Results

Discussion

Disclosures

Acknowledgment

Physiol Behav

Am J Hypertens

J Psychosom Res

Personal Indiv Differ

The Global Burden of Disease: 2004 Update

Marital functioning and physical health: implications for social and personality psychology

Soc Pers Psychol Compass

The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health

Psychol Bull

High blood pressure and marital discord: not being nasty matters more than being nice

Health Psychol

High stored iron levels are associated with excess risk of myocardial infarction in Eastern Finnish men

Circulation