Background The impact of marital status on long term mortality following diagnoses of cardiovascular disease has been recently established and is being studied widely. Married patients with Acute Coronary Syndrome (ACS) have significantly improved mortality compared to single patients while the worst outcomes are seen among divorcees. However, the role of marital status alongside other traditional risk factors in the development of ACS has not been well studied. We addressed this gap by studying patients with Type 2 Diabetes Mellitus (T2DM), Hyperlipidaemia and Hypertension along with their marital status and investigated their respective risks of ACS over time.
Methods Anonymous information on patients with T2DM, Hyperlipidaemia and Hypertension including comorbidities and marital status was obtained from UK hospitals between 1st January 2000 and 31st July 2014. This data was amalgamated according to the Algorithm for Comorbidities, Associations, Length of stay and Mortality (ACALM) study protocol using ICD-10 and OPCS-4 coding. These patients were longitudinally followed-up for development of a new diagnosis of Acute Coronary Syndrome and analysis was performed using logistic regression adjusting for demographics, comorbidities/ Charlson Comorbidity Index and t-tests.
Results Overall 198,528 patients were followed up for a mean period of 5.5 years (S.D 3.9 years). Of these 65,349 had T2DM, 45,847 had Hyperlipidaemia and 152,005 had Hypertension. All patients were analysed according to their marital status at the start of the follow-up period. 3,582 patients had new ACS over the study period. Mean time to event was 6.2 years (S.D 4.0 years) and events were more common in males (62.5%). 37.5% of patients who had ACS had T2DM; 32.7% had Hyperlipidaemia and 73.2% had Hypertension. In the ACS group, 9.5% of patients were single; 54.4% married; 17.1% were divorced; 17.6% were widowed and 1.3% were co-habiting. Table 1 shows that breakdown of ACS according to marital status, comorbidities and time to event. The mean time to event was longer in married patients compared to single, divorced and widowed patients. Logistic regression analyses accounting for variations in age, gender, T2DM, Hypertension, Hyperlipidaemia and Charlson Co-morbidity Index showed that the prediction of new ACS was significantly lower in married patients compared to single, widowed and co-habiting patients.
Conclusion Marital status seems to have an impact on the time to ACS similar to traditional risk factors such as T2DM, Hypertension and Hyperlipidaemia. Married patients with risk factors seem to have longer time to ACS compared to single, widowed and co-habiting patients. Our study shows that marital status, in addition to its previously known impact on the long term mortality after development of cardiovascular disease, seems to impact the development and natural history of ACS in patients with cardiovascular risk factors.
Conflict of Interest None
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