Can divorce increase risk of acute myocardial infarction? Circulation. ahead of print.

Smoking, hypertension and diabetes are the major risk factors for myocardial infarction.Psychological/Social stress can affect cardiac functioning and contribute to myocardial infarctions.Divorce is linked to poorer physical health outcomes. Can divorce  significantly increase the chances of having acute myocardial infarction?
Matthew E. Dupre, Linda K. George, Guangya Liu and Eric D. Peterson from Duke University used a nationally representative sample ( from the Health and Retirement Study) of married people (~15,000) to answer this question.These participants were followed up during 1992 to 2010.


35% of the cohort had one or more divorces during the observation period.During the 200524 person-years of follow-up, 8% (n=1211) of the cohort had an Acute MI. Age-specific rates of AMI were consistently higher in those who were divorced compared with those who were continuously married. Associations were not accounted for by socioeconomic, psychosocial, behavioral, or physiological factors.

Women with multiple divorces were at especially high risk of AMI; and remarried women had risks that were similar in magnitude to divorced women.
Hazard ratio for women differed according to number of divorces. Those  who had 1 divorce = hazard ratio, 1.24; (95% confidence interval, 1.01–1.55), those with  ≥2 divorces =hazard ratio, 1.77; ( 95% confidence interval, 1.30–2.41). Remarriage didn’t help women. Among the remarried women= hazard ratio, 1.35 (95% confidence interval, 1.07–1.70) All the above ratio is in comparison with continuously married women after adjusting for multiple risk factors.

Men who remarried had no significant increase in risk.

This is the first prospective study on the cumulative association between divorce and MI.This study show that life time exposure to divorce is a serious risk factor for acute MI. Women with multiple divorce are at significant risk. Remarriage protects men but not women.

Factors like loss of income, changes in health insurance, depressive symptoms, smoking , alcohol use etc did not account for the excess risk observed. Authors suggest that direct biological mechanisms of stress ( inflammatory activation) may explain the observed association.

Limitations: Patient reported data was used to find out acute MI event.

Comment: It would be interesting to see the association ( with MI) in subgroups of divorced people. For example among those who consider divorce as an escape from stressful relationships.It will help us explore the cognitive and emotional mediators of divorce and how they may bring about physical effects.  Previous research have shown that cardiac health is affected by emotional status/stress/traumatic events. Higher risk among women needs special attention.Men possibly get along easily with relationship changes where as  women may be continuing to struggle emotionally.

Summary of the article:
Association Between Divorce and Risks for Acute Myocardial Infarction.Matthew E. Dupre, PhD; Linda K. George, PhD; Guangya Liu, PhD; Eric D. Peterson, MD, MPH.Circ Cardiovasc Qual Outcomes. 2015;8:00-00. DOI: 10.1161/CIRCOUTCOMES.114.001291.) Ahead of print.

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