Marital stress associated with increased risk for recurrent cardiac events in women with coronary heart disease

December 18, 2000

But unlike previous findings in men, work stress does not predict poor prognosis in women

CHICAGO - Among women with coronary heart disease, the risk of having a recurrent coronary event is increased for those who experience severe stress in their marriages or live-in relationships, according to an article in the December 20 issue of The Journal of the American Medical Association (JAMA).

Kristina Orth-Gomer, M.D., Ph.D., of Karolinska Institutet, Stockholm, Sweden, and colleagues investigated the prognostic impact of psychosocial work stress and marital stress among women with coronary heart disease (CHD). They conducted a population-based, prospective follow-up study of women in Stockholm who were hospitalized for acute myocardial infarction (AMI) or unstable angina pectoris between February 1991 and February 1994. Patients were followed up for a median of 4.8 years, from the date of clinical examination until August 1997. A total of 292 women aged 30 to 65 took part in the Stockholm Female Coronary Risk (FemCorRisk) Study. The researchers looked at recurrent coronary events, including cardiac death, AMI, and revascularization procedures, and measured marital stress and work stress. Marital stress was assessed using the Stockholm Marital Stress Scale, a structured interview. Work stress was assessed using a questionnaire that measures the ratio of work demand to work control.

According to background information cited in the study, women younger than the age of 70 have a worse prognosis than men following AMI, but the causes are poorly understood. Studies in men suggest that psychosocial factors are important determinants of cardiovascular health. In particular, work stress has been associated with increased CHD incidence and poorer prognosis in men. Among women in this age group, psychosocial stress in relation to CHD has rarely been studied, and models of psychosocial influences are usually derived from studies in men.

Among the 292 women in the FemCorRisk Study, 64 percent were married or cohabiting with a male partner and 70 percent of those women were working at the time of examination. Among the women living with husband or partners, there were eight deaths, including five from ischemic heart disease. Eleven patients had a recurrent AMI, 24 had percutaneous transluminal coronary angioplasty, and 22 had coronary artery bypass grafting during the follow-up period. A total of 52 patients either died of ischemic heart disease, had a recurrent AMI or a revascularization procedure, or a combination of these, and were considered to have had a new coronary event.

"Among women who were married or cohabiting with a male partner [187 patients], marital stress was associated with a 2.9-fold increased risk of recurrent events after adjustment for age, estrogen status, education level, smoking, diagnosis at index event, diabetes mellitus, systolic blood pressure, triglyceride level, high-density lipoprotein cholesterol level, and left ventricular dysfunction," the authors write.

Among working women in the study, work stress did not predict new coronary events. "In contrast to the findings for marital stress, there was no statistical evidence of work stress effect on recurrent coronary events for either cohabiting women or those living alone," the authors write.

"These findings differ from previous findings in men and suggest that specific preventive measures be tailored to the needs of women with CHD," they continue.

The authors believe there is a need for further investigation into the effects of family and work stress in combination, as well as women's multiple roles and role conflicts in relation to cardiovascular health.

"In conclusion, our results suggest that stressful experience from marital relationships may seriously affect prognosis in women with CHD, whereas living alone without a partner had no effect," they write. "Further research is needed to examine the reproducibility and the pathogenic pathways of these novel findings." (JAMA. 2000; 284:3008-3014)
Editor's Note: This work was supported by grants from the U.S. National Institutes of Health, the Swedish Council for Work Life Research, the Swedish Medical Research Council, the Swedish Labor Market Insurance Company and the Swedish Heart and Lung Foundation.

This release is reproduced verbatim and with permission from the American Medical Association as a service to reporters interested in health and behavioral change. For more information about The Journal of the American Medical Association or to obtain a copy of the study, please contact the American Medical Association's Science News Department at (312) 464-5374.

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