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Author Notes:

Correspondence to: Arshed A. Quyyumi, MD, Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Rd. NE, Suite 507, Atlanta, GA 30322. E‐mail: aquyyum@emory.edu

Dr Schultz and Dr Hayek contributed equally to this work.

We would like to acknowledge the members of the Emory Biobank Team, Emory Clinical Cardiovascular Research Institute, and Atlanta Clinical and Translational Science Institute for recruitment of participants, compilation of data, and preparation of samples.

Schultz, Hayek, and Quyyumi had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosures - None


Research Funding:

Quyyumi is supported by 5P01HL101398‐02, 1P20HL113451‐01, 1R56HL126558‐01, 1RF1AG051633‐01, R01 NS064162‐01, R01 HL89650‐01, HL095479‐01, 1U10HL110302‐01, 1DP3DK094346‐01, 2P01HL086773‐06A1.

Hayekare supported by the Abraham J. & Phyllis Katz Foundation (Atlanta, GA).

Tahhan is supported by the Abraham J. & Phyllis Katz Foundation (Atlanta, GA) and National Institutes of Health/National Institute of Aging grant AG051633.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • cardiovascular disease
  • divorce
  • marital status
  • mortality
  • never married
  • socioeconomic position
  • unmarried
  • widowed
  • RISK
  • MEN

Marital Status and Outcomes in Patients With Cardiovascular Disease

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Journal Title:

Journal of the American Heart Association


Volume 6, Number 12


Type of Work:

Article | Final Publisher PDF


Background--Being unmarried is associated with decreased survival in the general population. Whether married, divorced, separated, widowed, or never-married status affects outcomes in patients with cardiovascular disease has not been well characterized. Methods and Results--A prospective cohort (inception period 2003-2015) of 6051 patients (mean age 63 years, 64% male, 23% black) undergoing cardiac catheterization for suspected or confirmed coronary artery disease was followed for a median of 3.7 years (interquartile range: 1.7-6.7 years). Marital status was stratified as married (n=4088) versus unmarried (n=1963), which included those who were never married (n=451), divorced or separated (n=842), or widowed (n=670). The relationship between marital status and primary outcome of cardiovascular death and myocardial infarction was examined using Cox regression models adjusted for clinical characteristics. There were 1085 (18%) deaths from all causes, 688 (11%) cardiovascular-related deaths, and 272 (4.5%) incident myocardial infarction events. Compared with married participants, being unmarried was associated with higher risk of all-cause mortality (hazard ratio [HR]: 1.24; 95% confidence interval [CI] , 1.06-1.47), cardiovascular death (HR: 1.45; 95% CI, 1.18-1.78), and cardiovascular death or myocardial infarction (HR: 1.52; 95% CI, 1.27-1.83). Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated (HR: 1.41; 95% CI, 1.10-1.81), widowed (HR: 1.71; 95% CI, 1.32-2.20), or never married (HR: 1.40; 95% CI, 0.97-2.03). The findings persisted after adjustment for medications and other socioeconomic factors. Conclusions--Marital status is independently associated with cardiovascular outcomes in patients with or at high risk of cardiovascular disease, with higher mortality in the unmarried population. The mechanisms responsible for this increased risk require further study.

Copyright information:

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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