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Original research
Marital status, telomere length and cardiovascular disease risk in a Swedish prospective cohort
  1. Ruoqing Chen1,2,
  2. Yiqiang Zhan1,
  3. Nancy Pedersen1,
  4. Katja Fall1,3,
  5. Unnur A Valdimarsdóttir1,4,
  6. Sara Hägg1,
  7. Fang Fang1
  1. 1 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  2. 2 Clinical Epidemiology Division Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
  3. 3 Clinical Epidemiology and Biostatistics School of Medical Sciences, Örebro University, Örebro, Sweden
  4. 4 Centre of Public Health Sciences Faculty of Medicine, University of Iceland, Reykjavík, Iceland
  1. Correspondence to Dr Yiqiang Zhan, Karolinska Institutet Department of Medical Epidemiology and Biostatistics, Stockholm 17177, Sweden; yiqiang.zhan{at}


Objective To investigate if marital status is associated with risk of cardiovascular disease (CVD) and to explore the potential influence of leucocyte telomere length (LTL), a marker of biological ageing, on such association.

Design Population-based prospective cohort study

Settings Swedish Twin Registry.

Participants Based on the Screening Across the Lifespan Twin Study from the Swedish Twin Registry, we included 10 058 twins born between 1900 and 1958 who underwent an interview between 1998 and 2002 during which information about marital status was collected. Blood samples from these participants were subsequently collected between 2004 and 2008 and used for LTL assessment using quantitative PCR technique.

Main outcome measures Incident cases of CVD were identified through the Swedish Patient Register and Causes of Death Register through December 31, 2016. Multivariable linear regression and Cox proportional hazards regression models were used to estimate the regression coefficients (βs) and HRs with 95% CIs respectively. Potential confounders included age, sex, educational attainment and body mass index.

Results A total of 2010 participants were diagnosed with CVD during a median follow-up of 9.8 years. LTL was shorter among individuals living singly, including those who were divorced or separated (β:−0.014, 95% CI: −0.035, 0.007), widowed (β:−0.035, 95% CI: −0.061, –0.010), or living alone (β:−0.033, 95% CI: −0.052, –0.014), than individuals who were married or cohabitating. One SD increase of LTL was associated with a lower risk of CVD (HR: 0.79, 95% CI: 0.66, 0.93). Individuals who were divorced or separated, widowed, or living alone had a higher risk of CVD than individuals who were married or cohabitating. The summary HR of CVD was 1.21 (95% CI: 1.08, 1.35) when comparing individuals who were living singly, regardless of reason, with the individuals who were married or cohabitating. LTL appeared to mediate little of the association between marital status and CVD (HR additionally adjusted for LTL: 1.20; 95% CI: 1.08, 1.34).

Conclusions Living singly, regardless of reason, was associated with a shorter LTL and a higher risk of CVD. The association between marital status and CVD was however not greatly attributable to telomere shortening.

  • cardiac risk factors and prevention
  • epidemiology
  • quality and outcomes of care
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  • Contributors RC and FF conceived the study design. NP and SH collected the data. RC and YZ analysed the data. All authors contributed to the manuscript editing and provided comments and suggestions.

  • Funding The study was partially financed by the Karolinska Institutet (the Strategic Research Area in Epidemiology and the Senior Researcher Award to FF).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Regional Ethical Review Board in Stockholm.

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

  • Data availability statement Data are available upon reasonable request.

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