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Original research article
Marital status and risk of cardiovascular diseases: a systematic review and meta-analysis
  1. Chun Wai Wong1,
  2. Chun Shing Kwok1,
  3. Aditya Narain1,
  4. Martha Gulati2,
  5. Anastasia S Mihalidou3,
  6. Pensee Wu4,5,
  7. Mirvat Alasnag6,
  8. Phyo Kyaw Myint7,
  9. Mamas A Mamas1
  1. 1 Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
  2. 2 University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
  3. 3 Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards and Macquarie University, Sydney, New South Wales, Australia
  4. 4 Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Keele, UK
  5. 5 Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, UK
  6. 6 Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
  7. 7 Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Chun Shing Kwok, Cardiovascular Research Group, Keele University, Stoke-on-Trent ST4 7QB, UK; shingkwok{at}


Background The influence of marital status on the incidence of cardiovascular disease (CVD) and prognosis after CVD is inconclusive. We systematically reviewed the literature to determine how marital status influences CVD and prognosis after CVD.

Methods A search of MEDLINE and Embase in January 2018 without language restriction was performed to identify studies that evaluated the association between marital status and risk of CVD. Search terms related to both marital status and CVD were used and included studies had to be prospective in design. The outcomes of interest were CVD, coronary heart disease (CHD) or stroke incidence and mortality. We performed random effects meta-analysis stratified by the types of population by calculating odds ratios (OR) and 95% confidence intervals (95% CI).

Results Our analysis included 34 studies with more than two million participants. Compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42; 95% CI 1.00 to 2.01), CHD (OR 1.16,95% CI 1.04 to 1.28), CHD death (OR 1.43,95% CI 1.28 to 1.60) and stroke death (OR 1.55,95% 1.16 to 2.08). Being divorced was associated with increased odds of CHD (P<0.001) for both men and women while widowers were more likely to develop a stroke (P<0.001). Single men and women with myocardial infarction had increased mortality (OR 1.42, 95% CI 1.14 to 1.76) compared with married participants.

Conclusions Marital status appears to influence CVD and prognosis after CVD. These findings may suggest that marital status should be considered in the risk assessment for CVD and outcomes of CVD based on marital status merits further investigation.

  • meta-analysis
  • systemic review
  • acute coronary syndromes
  • stroke

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  • Contributors MAM and CSK conceived and planned the study. CSK and CWW performed the search for relevant studies. Data were screened, extracted and analysed by CSK and CWW. CWW wrote the first draft of the paper. All authors contributed to the interpretation of the findings and critically revised it for intellectual content.

  • Funding This work is supported by the ASPIRE Summer Studentship programme at Keele University.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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