Association Between Divorce and Risks for Acute MI | Journal Scan

Study Questions:

What is the association between lifetime exposure to divorce and the incidence of acute myocardial infarction (AMI) in US adults?

Methods:

The Health and Retirement Study was used to assess a prospective cohort of ever-married adults aged 45-80 years (n = 15,827) born between 1942 and 1953, and followed biennially from 1992 to 2010. Socioeconomic, lifestyle, and nonlipid risk factors were available. Approximately 14% of men and 19% of women were divorced at baseline, and more than one third of the cohort had ≥1 divorce in their lifetime.

Results:

Mean age of men was 55 years and women 53.5 years (p < 0.001); 65% had no divorces, 26% one divorce, and 8.3% one or more, and 23% of divorces were remarried. In 200,524 person-years of follow-up, 8% (n = 1,211) of the cohort had an AMI, and age-specific rates of AMI were consistently higher in those who were divorced compared with those who were continuously married (p < 0.05). Results from competing risk hazard models showed that AMI risks were significantly higher in women who had one divorce (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.01-1.55), ≥2 divorces (HR, 1.77; 95% CI, 1.30-2.41), and among the remarried (HR, 1.35; 95% CI, 1.07-1.70) compared with continuously married women after adjusting for multiple risk factors. Multivariable-adjusted risks were elevated only in men with a history of ≥2 divorces (HR, 1.30; 95% CI, 1.02-1.66) compared with continuously married men. Men who remarried had no significant risk for AMI. Interaction terms for sex were not statistically significant. Losses of income and health insurance, and increases in depressive symptoms, alcohol use, and smoking did not account for the excess risks attributable to a history of divorce in men and women.

Conclusions:

Divorce is a significant risk factor for AMI. The risks associated with multiple divorces are especially high in women and are not reduced with remarriage.

Perspective:

The findings extend the cardiovascular risk associated with lifetime exposure to social stressors (e.g., divorce and job loss), which in this and other studies are the magnitude of major established risk factors including hypertension, smoking, and diabetes. Studies such as this cannot explore whether the incremental risk in women versus men is related to who triggered the divorce.

Clinical Topics: Prevention, Smoking

Keywords: Cardiovascular Diseases, Depression, Divorce, Follow-Up Studies, Incidence, Life Style, Marriage, Myocardial Infarction, Primary Prevention, Precipitating Factors, Prospective Studies, Risk Factors, Smoking


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