Close Relationships and the Incidence of Coronary Events: Where is the Data?

Abstract & Commentary

By Joseph Varon, MD, FACP, FCCP, FCCM, Clinical Professor of Medicine, The University of Texas Health Science Center, Houston; Professor of Acute and Continuing Care, The University of Texas Health Science Center at Houston. Dr. Varon reports no financial relationship to this field of study.

Synopsis: Coronary events occurred more commonly in patients who had experienced negative aspects of close relationships.

Source: De Vogli R, et al. Arch Intern Med. 2007; 167:1951-1957.

This prospective, cohort study was conducted among nonindustrial civil servants aged 35 to 55 years who worked in London from 1985-1988. The phase I of this study included 9011 respondents of whom 6114 were men and 2897 were women. The participants were followed up for a period of 12.2 years. The association of negative aspects of close relationships as well as the incidence of new coronary artery disease (CAD) events was analyzed at the conclusion of the study. Specifically, in phase II of the study (1989-1990), participants answered a survey that included 15 items about negative aspects of personal relationships. Sources of negative aspects of personal relationships were divided into: partner or non-partner.

The main outcome variable analyzed was the incidence of new coronary events between phase II (1989-1990) and the end of the study (2003-2004). Coronary events included fatal and non-fatal acute myocardial infarction or angina.

Over the study period, negative close relationships were more likely to be experienced by younger individuals, women and men in the lower employment grades. There were 8499 participants that were free of CAD at enrollment, of whom 589 reported a coronary event during the study period. After adjustments for other variables, such as age, sex, marital status, obesity, diabetes mellitus, hyperlipidemia, and hypertension, a direct relationship was found between a stressful close relationship and new coronary events. Indeed, those participants that experienced high levels of negative close relationships were 1.34 times (95% Confidence Intervals 1.02-1.55) more likely to have a coronary event.

Commentary

CAD remains a prevalent illness among Western societies. It is a serious disorder resulting in significant impairment of health or death. Clinicians tend to emphasize risk factors to avoid among their patients trying to prevent CAD. Among them, early diagnosis and treatment of hypertension, hyperlipidemia and diabetes mellitus are commonly sought and aggressively treated. The impact of stressful relationships, however, is often neglected

This study is particularly interesting because it corroborates prior research that has shown that the negative aspects of marital quality adversely affect the individual's health.1 In the study by De Vogli and associates, the effect of negative close relationships was independent of any sociodemographic characteristic, pre-existing conditions and co-morbidities, psychosocial factors or health-related behaviors (ie, regular exercise, smoking, etc).2 These negative close relationships were powerful predictors of health.

Even though the study was well designed from a statistical standpoint, readers must be aware that there may be a series of pathways that may link this association. For example, marital distress has previously been found to be associated with lack of exercise, alcohol intake, medical non-compliance.3 High levels of anger have been found by other investigators and have been associated with CAD.4 The specific biochemical role of negative relationships will likely require further research.

References

1. Bookwala J. J Aging Health. 2005;17:85-104.

2. De Vogli R, et al. Arch Intern Med. 2007;167:1951-1957.

3. Kiecolt-Glaser JK, et al. Psycholl Bull. 2001;127:472-503.

4. Hemingway H, et al. BMJ. 1999;318:1460-1467.