Bad Marriage, Bad Heart?

Marriages and close friendships marked by negativity -- such
as conflict and adverse exchanges -- boost the risk of heart disease, according
to a new study.

"Those in a negative relationship were 34% more likely to have a
coronary event in the 12 years of follow-up," says Roberto De Vogli, PhD,
MPH, a researcher for the study, published in the Archives of Internal
Medicine.

Even after taking into account other factors that could contribute to heart
disease, such as depression, men and women with negative aspects in
relationships still had a 25% increase in heart disease risk over the follow-up
period, says De Vogli, an epidemiologist at University College London. "We
found the effect is there not only for married people," he says, but also
for unmarried people who have negative relationships with close friends.

Putting It in Perspective

In past research, De Vogli tells WebMD, many researchers have found that
social relationships, including marriage, are associated with better health and
less cardiovascular disease.B "The more friends, the better" has
been the assumption.

Yet there were contradictory findings, he says, on the health benefits of
social support and the limited protective effects of being married on heart
disease risk among women.

"We expanded the debate [to be] about the quality of social
relationships rather than the quantity," he says.

A Closer Look

De Vogli's team asked 9,011 British civil servants, on average in their
mid-40s, to complete a questionnaire either between 1989 and 1990 or 1985 and
1988. They answered questions about up to four of their close personal
relationships, but mostly about their primary relationship.

More than 64% listed their spouse as their primary relationship. "Others
were close personal friends," De Vogli says of the unmarried
respondents.

The questions asked about the amount of emotional and practical support
respondents got from their relationships and about interactions. For instance,
they were asked how much stress or worries the spouse or friend caused them in
the past 12 months, how much talking to the person made situations seem worse,
how much the respondent would have liked more practical help from the partner
or friend, and how much more the person would have liked to confide in the
partner or friend, among other questions.

During the follow-up period of about 12 years, heart disease was reported by
589 men and women of the 8,499 respondents who finished the questionnaires.
None of the 8,499 respondents had any history of heart disease at the start of
the study.

Those who had high negativity in their marriage or close friendship -- such
as saying that talking to the partner or friend about problems made things seem
worse -- were 34% more likely to have a heart problem compared with those with
more positive interactions and low level of negativity. The increased risk
dropped to 25% after taking into account other variables that could contribute
to heart disease such as depression.

De Vogli didn't find an association between the level of practical support
or emotional support and heart disease risk.

What's behind the bad marriage -- bad heart link? People may mentally
"replay" the negative interactions, De Vogli and other researchers
suspect. "It can activate emotional responses, including depression or
hostility," he says, in turn boosting heart disease risk.B De Vogli
found the association held for both men and women and for those in higher and
lower social positions. More likely to have negative relationships, he did
find, were those in lower-grade jobs. Negative close relationships were less
likely in people who were never married.

Second Opinion

"It's an intriguing finding," says Robert Allan, PHD, a clinical
assistant professor of psychology in psychiatry at New York-Presbyterian
Hospital/Weil Cornell Medical Center. He reviewed the study for WebMD.

"In this study, they controlled for many variables [that could
contribute to heart problems], including age, sex, marital status, high blood
pressure, and diabetes," says Allan, an expert in the field of anger
management with a specialty in coronary risk reduction.B

Overall, he says, the link De Vogli's team found between negative
relationships and heart disease is not "huge." Still, "this is one
study that adds to a significant database suggesting that negative effect is
bad for both quality of life and for the heart."

It's a wake-up call to work on improving relationships as one way to improve
cardiac health, says Allan.

By Salynn Boyles
Reviewed by Louise Chang
B)2005-2006 WebMD, Inc. All rights reserved