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Marital Status, Marital Strain, and Risk of Coronary Heart Disease or Total Mortality: The Framingham Offspring Study

From the Eaker Epidemiology Enterprises, LLC (E.D.E.), Gaithersburg, Maryland; Department of Mathematics and Statistics (L.M.S., R.B.D.), Boston University School of Public Health, Boston, Massachusetts; Departments of Neurology (M.K.-H.), and Cardiology (E.J.B.), Boston University School of Medicine, Boston, Massachusetts; and The National Heart, Lung and Blood Institutes’ Framingham Heart Study (L.M.S., M.K.-H., R.B.D., E.J.B.), Framingham, Massachusetts.

Address correspondence and reprint requests to Elaine D. Eaker, Eaker Epidemiology Enterprises, LLC, 25015 Dunterry Court, Gaithersburg, MD 20882. E-mail: eakerepi{at}tznet.com

Objective: To determine if marriage and marital strain are related to the 10-year coronary heart disease (CHD) incidence or total mortality. Research has demonstrated associations between marital strain and prognosis of heart disease, but little research has addressed the association between specific aspects of marital strain and incident CHD.

Methods: From 1984 to 1987, 3682 participants (mean age 48.5 ± 10.1 (standard deviation) years; 52% women) of the Framingham Offspring Study were examined; measures of marital status, marital strain, and risk factors for CHD were collected at the baseline examination. The present study describes the 10-year follow-up for incident CHD and total mortality.

Results: After adjusting for age, systolic blood pressure, body mass index, cigarette smoking, diabetes, and total cholesterol/high density cholesterol, the married men compared with unmarried men were almost half as likely to die during follow-up (hazard ratio (HR) = 0.54; 95% confidence interval (CI): 0.34–0.83). Women who "self-silenced" during conflict with their spouse, compared with women who did not, had four times the risk of dying (HR = 4.01; 95% CI: 1.75–9.20). Men with wives who were upset by work were 2.7 times more likely to develop CHD (HR = 2.71; 95% CI: 1.22–6.03). Marital happiness, satisfaction, and disagreements were not related to the development of CHD or death in men or women.

Conclusions: Our study suggests that marital communication, conflict, and strain are associated with adverse health outcomes. Further research into the influence of marital stress on health is merited.

Key Words: coronary heart disease • mortality • cohort study • marital strain • epidemiology

Abbreviations: CHD = coronary heart disease; HR = hazard ratio; CI = confidence interval.

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