Marital Stress Tied to Worse Outcome in Young MI Patients

Marlene Busko

November 02, 2022

Severe marital stress was associated with worse recovery after myocardial infarction (MI) in a large US cohort of married/partnered patients aged 55 years or younger.

Compared with patients who reported no or mild marital stress a month after their MI, patients who reported severe marital stress had worse physical and mental health, worse generic and cardiovascular quality of life, more frequent angina symptoms, and a greater likelihood of having a hospital readmission a year later.

These findings held true after adjusting for gender, age, race/ethnicity, and baseline health status (model 1) and after further adjusting for education and income levels and employment and insurance status (model 2).

A greater percentage of women than men reported having severe marital stress (39% vs 30%; P = .001).

Cenjing Zhu, MPhil, a PhD candidate at the Yale School of Public Health, New Haven, Connecticut, and colleagues will present this study at the American Heart Association (AHA) Scientific Sessions 2022, which will take taking place November 5 to 7 in Chicago and online.

The results show that "both patients and care providers should be aware that stress experienced in one's everyday life, such as marital stress, can affect AMI [acute MI] recovery," Zhu told | Medscape Cardiology in an email.

Healthcare providers should consider incorporating screening for everyday stress during follow-up patient visits to better spot people at high risk of a poor recovery and further hospitalizations, she added. When possible, they could guide patients to resources to help them manage and reduce their stress levels.

According to Zhu, the findings suggest that "managing personal stress may be as important as managing other clinical risk factors during the recovery process."

This study in younger patients with MI "shows that high levels of marital stress impair heart attack recovery, and women have greater impairment in their heart attack recovery compared to men," AHA spokesperson Nieca Goldberg, MD, who was not involved with this research, told | Medscape Cardiology.

The study shows that "clinicians have to incorporate mental health as part of their assessment of all patients," said Goldberg, a clinical associate professor of medicine at NYU Grossman School of Medicine and medical director of Atria New York City.

"Our mental health impacts our physical health," she noted. "Questions about marital stress should be included as part of an overall assessment of mental health. This means assessing all patients for stress, anxiety, and depression."

Patients who are experiencing marital stress should share the information with their doctor and discuss ways to be referred to therapists and cardiac rehabilitation providers, she said.

"My final thought is, women have often been told that their cardiac symptoms are due to stress by doctors. Now we know stress impacts physical health and [is] no longer an excuse but a contributing factor to our physical health."

Does Marital Stress Affect Young MI Recovery?

Previous literature has linked psychological stress with worse cardiovascular outcomes, Zhu noted.

However, little is known about the prognostic impact of marital stress on 1-year health outcomes for younger people who survive an MI.

To investigate this, the researchers analyzed data from participants in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study.

The current study comprised 1593 adults, including 1020 female participants (64%), who were treated for MI at 103 hospitals in 30 US states.

VIRGO enrolled participants in a 2:1 female-to-male ratio so as to enrich the inclusion of women, Zhu explained.

In the study, "partnered" participants were individuals who self-reported as "living as married/living with a partner." There were 126 such patients (8%) in the current study.

The mean age of the patients was 47, and about 90% were 40 to 55 years old. Three quarters were White, 13% were Black, and 7% were Hispanic.

Marital stress was assessed on the basis of patients' replies to 17 questions in the Stockholm Marital Stress Scale regarding the quality of their emotional and sexual relationships with their spouses/partners.

The researchers divided patients into three groups on the basis of their marital stress: mild or absent (lowest quartile), moderate (second quartile), and severe (upper 2 quartiles).

At 1 year after their MI, patients replied to questionnaires that assessed their health, quality of life, and depressive and angina symptoms. Hospital readmissions were determined on the basis of self-reports and medical records.

Compared to participants who reported no or mild marital stress, those who reported severe mental stress had significantly worse scores for physical and mental health and generic and cardiovascular quality of life, after adjusting for baseline health and demographics. They had worse scores for mental health and quality of life, after further adjusting for socioeconomic status.

In the fully adjusted model, patients who reported severe marital stress were significantly more likely to report more frequent chest pain/angina (odds ratio [OR], 1.49; 95% CI, 1.06 – 2.10; P = .023) and to have been readmitted to hospital for any cause (OR, 1.45; 95% CI, 1.04 – 2.00; P = .006), compared to the patients who reported no or mild marital stress.

Study limitations include the fact that the findings are based on self-reported questionnaire replies; they may not be generalizable to patients in other countries; and they do not extend beyond a period of 1 year.

The researchers call for further research "to understand this complex relationship and potential causal pathway associated with these findings."

"Additional stressors beyond marital stress, such as financial strain or work stress, may also play a role in young adults' recovery, and the interaction between these factors require further research," Zhu noted in a press release from the AHA.

The study was funded by Canadian Institutes of Health Research. The VIRGO study was funded by the National Heart, Lung, and Blood Institute. Zhu and Goldberg have disclosed no relevant financial relationships.

American Heart Association (AHA) Scientific Sessions 2022: Abstract SU3051. Presented November 2022.

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