Marital Failure and Subsequent Heart Failure: A Prospective Study

Loss of a stable spousal relationship has been associated with a high risk of morbidity and premature death, yet there is limited evidence on the association between marital failure and the risk of subsequent heart failure (HF). We examined the association between marital failure and the risk of subsequent HF in large prospective studies. This cohort study utilized data from Kailuan Study I and Kailuan Study II. Marital status was assessed through multiple self-reports. HF cases were identified via biennial interviews, hospital records, social insurance, and death registries, confirmed by cardiologists. Associations were analyzed using Cox proportional hazards models. Among the 125 042 participants (mean age, 55.3 years; 83.1% men), 6042 (4.83%) experienced marital failure. During a median follow-up of 13.5 years (interquartile range, 9.00-14.1 years), 3779 subsequent HF cases were documented. Compared with marital stability, the hazard ratio for HF was 1.30 (95% CI, 1.14-1.49) for marital failure, adjusting for sociodemographic and lifestyle factors, biochemical parameters, and medical history. The association was stronger in individuals with higher educational levels and those with poorer lifestyle score, as assessed by smoking status, drinking status, physical activity, salt diet, and body mass index, relative to their counterparts (P<0.05 for interaction for both). In this large prospective study, we found that marital failure was associated with a higher risk of subsequent HF compared with marital stability, particularly among individuals with high educational levels and poor lifestyle habits. Marital failure may be a noteworthy socioeconomic factor that assists in identifying at-risk populations and developing supportive strategies for better health outcomes accordingly.