(Reuters Health) - Women who have been divorced once, or men who have been divorced at least twice, are more likely to have a heart attack than people who get and stay married, according to a new study.
“The negative health consequences of divorce have been known for some time,” said lead author Matthew E. Dupre of Duke Clinical Research Institute in Durham, North Carolina.
Remarriage only reverses the risk for men, the researchers also found. And for women divorced at least twice, the heart attack risk was comparable to that of having diabetes or high blood pressure.
The researchers analyzed data on more than 15,000 adults ages 45 to 80 at the beginning of the study period, who had been married at least once and were followed from 1992 to 2010.
At the outset, 14% of men and 19% of women were divorced. By the end of the study, more than a third of people had gone through at least one divorce.
Over the 18-year study period, 1211 people suffered a heart attack, and this was more likely to happen to those who had been divorced, according to the April 14 online paper in Circulation: Cardiovascular Quality and Outcomes. The authors accounted for age, socioeconomic, behavioral and health factors.
Women who had one divorce were 24% more likely to have a heart attack than women who were continuously married, and those who had been divorced at least twice were 77% more likely to have one.
Remarried women were 35% more likely than women who were continuously married to have a heart attack.
For men, risk only increased for those who had been divorced twice or more. They were 30% more likely to have a heart attack than men who remained married or who remarried.
“Earlier studies have suggested that marital loss has a greater impact on the health of women than men,” Dupre told Reuters Health by email. “The reasons for these differences are not entirely known; however, the prevailing view is that divorced women suffer greater economic losses and emotional distress than divorced men.”
“Men are also much more likely to remarry after divorce than women, and among those who remarry, men remarry sooner than women,” he said.
Though the results offer strong evidence that divorce increases heart attack risk, the authors were not able to account for other potentially important factors like elevated stress, anxiety and the loss of social support or changes in medication adherence, Dupre said.
They also were not able to account for whether the risk rises or falls over time following divorce, he said.
“There's already a substantial literature linking changes in marital status to physical health,” said David A. Sbarra of the psychology department at the University of Arizona in Tucson. “I would have predicted men to be at increased risk following divorce, but this is not what the paper reports.”
The immediate emotional shock of ending a relationship may lead to cardiovascular changes, or people who get a divorce may change their behavior, may start smoking to manage the stress of separation, for example, he told Reuters Health by email.
“The difficult spot all of us are in when working on this topic is that you cannot randomly assign people to divorce,” Sbarra said.
Divorce may be a proxy for other variables, like hostility, which lead people to end marriages and also convey heart attack risk, he said.
“If you feel your divorce was done for good reasons, you've coped well with the transition (after a period of grief, you've got most of your life back together . . . or, at least, you feel headed in the right direction), these results may not apply,” he said.
The study only involved people who had ever married, which includes 95% of the older adult population, but not those who remained single, Dupre said.
People cannot change their marital history in order to reduce their heart attack risk, but recognizing an increased risk may improve doctors’ decision making or screening for divorced people, he said.
“A greater recognition of social stressors will help physicians identify and treat adults at potentially high risk of having a heart attack, as well as provide patients a new (or heightened) awareness of how the social world can get under our skin and damage our heart,” he said.
Circ Cardiovasc Qual Outcomes 2015.