Effect of women's marital status on heart disease

A story published today in USA Today reports that a happy marriage helps middle-age professional women avoid heart disease and strokes, but staying in the frying pan of single life is better for a woman's health than landing in the fire of a troubled union, a 12-year study suggests today.

Marital status and the quality of marriage both matter as women move into their postmenopausal years when the risk of cardiovascular disease grows, says researcher Wendy Troxel of the University of Pittsburgh.

She and psychologist Karen Matthews, who will speak at the American Psychosomatic Society meeting in Orlando, have followed 422 premenopausal women into their 50s to see how their marital states before menopause predict later health effects.

Study participants were upper-middle class. Compared with single women or those who were happily married in their 40s, the unhappily married or divorced were more than twice as likely to be at risk for heart attacks and strokes after menopause. There were too few widows to draw any conclusions about their risk, Troxel says.

The higher risk for unhappily wed and divorced women was significant even after accounting for age and health.

The symptoms researchers checked for are lumped under the umbrella of "the metabolic syndrome," and there's increasing evidence that they put adults at high risk for heart disease and strokes. Blood pressure, blood fats, glucose and tummy fat are considered in diagnosing the syndrome.

Depending on the study, marriage has been found to benefit and to impede women's health, but the research tended to lump all married women together, Troxel says.

Newer studies are separating happy and unhappy wives and are concluding that a good marriage is therapeutic, but a bad one may be worse than none at all.

Women in miserable marriages are stressed. Stress can drive up blood pressure and trigger stress hormone surges that make it harder to process insulin, putting women at risk for diabetes, which in turn is a risk factor for heart disease. There's also evidence that women in happier marriages take better care of themselves.

Among the upscale women she studied, "the single ones often choose to be single. They may have good social networks and great jobs — all in all, less stress than women in bad marriages." Low-income singles may not be as healthy, she says.

Cardiovascular disease takes time to develop, so the higher risk among divorced women may reflect cumulative stress, Troxel says. Some were in bad marriages for a long time, and others might suffer continuing divorce-linked stress.

Unhappy spouses often have sleep disturbances that can raise blood pressure, says University of Utah psychologist Timothy Smith. "Marriage has such a strong effect because your spouse is inescapable. You can get away from your boss, but you can't get away from your spouse, even at night."

That can be great — or terrible. "There are different ways to be married, and different ways to be unmarried," Smith says. "You have to look at quality of life and the quality of relationships."