Marital status and risk of cardiovascular diseases

A systematic review and meta-analysis

Chun Wai Wong, Chun Shing Kwok (Corresponding Author), Aditya Narain, Martha Gulati, Anastasia S. Mihalidou, Pensee Wu, Mirvat Alasnag, Phyo K. Myint, Mamas A. Mamas

Research output: Contribution to journalArticle

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Abstract

Background The influence of marital status on the incidence of cardiovascular disease (CVD) and prognosis after CVD is inconclusive. We systematically reviewed the literature to determine how marital status influences CVD and prognosis after CVD.

Methods A search of MEDLINE and Embase in January 2018 without language restriction was performed to identify studies that evaluated the association between marital status and risk of CVD. Search terms related to both marital status and CVD were used and included studies had to be prospective in design. The outcomes of interest were CVD, coronary heart disease (CHD) or stroke incidence and mortality. We performed random effects meta-analysis stratified by the types of population by calculating odds ratios (OR) and 95% confidence intervals (95% CI).

Results Our analysis included 34 studies with more than two million participants. Compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42; 95% CI 1.00 to 2.01), CHD (OR 1.16,95% CI 1.04 to 1.28), CHD death (OR 1.43,95% CI 1.28 to 1.60) and stroke death (OR 1.55,95% 1.16 to 2.08). Being divorced was associated with increased odds of CHD (P<0.001) for both men and women while widowers were more likely to develop a stroke (P<0.001). Single men and women with myocardial infarction had increased mortality (OR 1.42, 95% CI 1.14 to 1.76) compared with married participants.

Conclusions Marital status appears to influence CVD and prognosis after CVD. These findings may suggest that marital status should be considered in the risk assessment for CVD and outcomes of CVD based on marital status merits further investigation.

Original languageEnglish
Pages (from-to)1937-1948
Number of pages12
JournalHeart
Volume104
Issue number23
Early online date19 Jun 2018
DOIs
Publication statusPublished - Dec 2018

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Marital Status
Meta-Analysis
Cardiovascular Diseases
Odds Ratio
Coronary Disease
Confidence Intervals
Widowhood
Divorce
Stroke
Mortality
Incidence
MEDLINE
Language
Myocardial Infarction

Cite this

Wong, C. W., Kwok, C. S., Narain, A., Gulati, M., Mihalidou, A. S., Wu, P., ... Mamas, M. A. (2018). Marital status and risk of cardiovascular diseases: A systematic review and meta-analysis. Heart, 104(23), 1937-1948. https://doi.org/10.1136/heartjnl-2018-313005

Marital status and risk of cardiovascular diseases : A systematic review and meta-analysis. / Wong, Chun Wai; Kwok, Chun Shing (Corresponding Author); Narain, Aditya; Gulati, Martha; Mihalidou, Anastasia S.; Wu, Pensee; Alasnag, Mirvat; Myint, Phyo K.; Mamas, Mamas A.

In: Heart, Vol. 104, No. 23, 12.2018, p. 1937-1948.

Research output: Contribution to journalArticle

Wong, CW, Kwok, CS, Narain, A, Gulati, M, Mihalidou, AS, Wu, P, Alasnag, M, Myint, PK & Mamas, MA 2018, 'Marital status and risk of cardiovascular diseases: A systematic review and meta-analysis', Heart, vol. 104, no. 23, pp. 1937-1948. https://doi.org/10.1136/heartjnl-2018-313005
Wong CW, Kwok CS, Narain A, Gulati M, Mihalidou AS, Wu P et al. Marital status and risk of cardiovascular diseases: A systematic review and meta-analysis. Heart. 2018 Dec;104(23):1937-1948. https://doi.org/10.1136/heartjnl-2018-313005
Wong, Chun Wai ; Kwok, Chun Shing ; Narain, Aditya ; Gulati, Martha ; Mihalidou, Anastasia S. ; Wu, Pensee ; Alasnag, Mirvat ; Myint, Phyo K. ; Mamas, Mamas A. / Marital status and risk of cardiovascular diseases : A systematic review and meta-analysis. In: Heart. 2018 ; Vol. 104, No. 23. pp. 1937-1948.
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title = "Marital status and risk of cardiovascular diseases: A systematic review and meta-analysis",
abstract = "Background The influence of marital status on the incidence of cardiovascular disease (CVD) and prognosis after CVD is inconclusive. We systematically reviewed the literature to determine how marital status influences CVD and prognosis after CVD.Methods A search of MEDLINE and Embase in January 2018 without language restriction was performed to identify studies that evaluated the association between marital status and risk of CVD. Search terms related to both marital status and CVD were used and included studies had to be prospective in design. The outcomes of interest were CVD, coronary heart disease (CHD) or stroke incidence and mortality. We performed random effects meta-analysis stratified by the types of population by calculating odds ratios (OR) and 95{\%} confidence intervals (95{\%} CI).Results Our analysis included 34 studies with more than two million participants. Compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42; 95{\%} CI 1.00 to 2.01), CHD (OR 1.16,95{\%} CI 1.04 to 1.28), CHD death (OR 1.43,95{\%} CI 1.28 to 1.60) and stroke death (OR 1.55,95{\%} 1.16 to 2.08). Being divorced was associated with increased odds of CHD (P<0.001) for both men and women while widowers were more likely to develop a stroke (P<0.001). Single men and women with myocardial infarction had increased mortality (OR 1.42, 95{\%} CI 1.14 to 1.76) compared with married participants.Conclusions Marital status appears to influence CVD and prognosis after CVD. These findings may suggest that marital status should be considered in the risk assessment for CVD and outcomes of CVD based on marital status merits further investigation.",
author = "Wong, {Chun Wai} and Kwok, {Chun Shing} and Aditya Narain and Martha Gulati and Mihalidou, {Anastasia S.} and Pensee Wu and Mirvat Alasnag and Myint, {Phyo K.} and Mamas, {Mamas A.}",
note = "Acknowledgement We acknowledge the ASPIRE Summer Studentship programme at Keele University for the support of this work. Funding This work is supported by the ASPIRE Summer Studentship programme at Keele University.",
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T1 - Marital status and risk of cardiovascular diseases

T2 - A systematic review and meta-analysis

AU - Wong, Chun Wai

AU - Kwok, Chun Shing

AU - Narain, Aditya

AU - Gulati, Martha

AU - Mihalidou, Anastasia S.

AU - Wu, Pensee

AU - Alasnag, Mirvat

AU - Myint, Phyo K.

AU - Mamas, Mamas A.

N1 - Acknowledgement We acknowledge the ASPIRE Summer Studentship programme at Keele University for the support of this work. Funding This work is supported by the ASPIRE Summer Studentship programme at Keele University.

PY - 2018/12

Y1 - 2018/12

N2 - Background The influence of marital status on the incidence of cardiovascular disease (CVD) and prognosis after CVD is inconclusive. We systematically reviewed the literature to determine how marital status influences CVD and prognosis after CVD.Methods A search of MEDLINE and Embase in January 2018 without language restriction was performed to identify studies that evaluated the association between marital status and risk of CVD. Search terms related to both marital status and CVD were used and included studies had to be prospective in design. The outcomes of interest were CVD, coronary heart disease (CHD) or stroke incidence and mortality. We performed random effects meta-analysis stratified by the types of population by calculating odds ratios (OR) and 95% confidence intervals (95% CI).Results Our analysis included 34 studies with more than two million participants. Compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42; 95% CI 1.00 to 2.01), CHD (OR 1.16,95% CI 1.04 to 1.28), CHD death (OR 1.43,95% CI 1.28 to 1.60) and stroke death (OR 1.55,95% 1.16 to 2.08). Being divorced was associated with increased odds of CHD (P<0.001) for both men and women while widowers were more likely to develop a stroke (P<0.001). Single men and women with myocardial infarction had increased mortality (OR 1.42, 95% CI 1.14 to 1.76) compared with married participants.Conclusions Marital status appears to influence CVD and prognosis after CVD. These findings may suggest that marital status should be considered in the risk assessment for CVD and outcomes of CVD based on marital status merits further investigation.

AB - Background The influence of marital status on the incidence of cardiovascular disease (CVD) and prognosis after CVD is inconclusive. We systematically reviewed the literature to determine how marital status influences CVD and prognosis after CVD.Methods A search of MEDLINE and Embase in January 2018 without language restriction was performed to identify studies that evaluated the association between marital status and risk of CVD. Search terms related to both marital status and CVD were used and included studies had to be prospective in design. The outcomes of interest were CVD, coronary heart disease (CHD) or stroke incidence and mortality. We performed random effects meta-analysis stratified by the types of population by calculating odds ratios (OR) and 95% confidence intervals (95% CI).Results Our analysis included 34 studies with more than two million participants. Compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42; 95% CI 1.00 to 2.01), CHD (OR 1.16,95% CI 1.04 to 1.28), CHD death (OR 1.43,95% CI 1.28 to 1.60) and stroke death (OR 1.55,95% 1.16 to 2.08). Being divorced was associated with increased odds of CHD (P<0.001) for both men and women while widowers were more likely to develop a stroke (P<0.001). Single men and women with myocardial infarction had increased mortality (OR 1.42, 95% CI 1.14 to 1.76) compared with married participants.Conclusions Marital status appears to influence CVD and prognosis after CVD. These findings may suggest that marital status should be considered in the risk assessment for CVD and outcomes of CVD based on marital status merits further investigation.

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DO - 10.1136/heartjnl-2018-313005

M3 - Article

VL - 104

SP - 1937

EP - 1948

JO - Heart

JF - Heart

SN - 1355-6037

IS - 23

ER -