Annals of Behavioral Medicine

, Volume 38, Issue 2, pp 115–123 | Cite as

Marital Status and Heart Rate Variability in Patients with Suspected Coronary Artery Disease

  • Gemma Randall
  • Mimi R. Bhattacharyya
  • Andrew Steptoe
Original Article

Abstract

Background

Married individuals are at reduced risk of cardiovascular disease morbidity and mortality. Recent research indicates that impaired heart rate variability (HRV) may contribute to cardiovascular disease morbidity and mortality and has also been associated with social isolation.

Purpose

We investigated associations between HRV and marital status in patients with suspected coronary artery disease (CAD).

Methods

Eighty-eight patients who were being investigated for suspected CAD (28 women, 60 men, mean age 61.6, 60% married) were recruited from three rapid access chest pain clinics in London. Heart rate variability was measured using 24-h electrocardiograms and analyzed using frequency and time-domain measures.

Results

Unmarried marital status was associated with reduced heart rate variability as indexed by both frequency and time-domain measures, independently of age, gender, beta-blocker use, depression ratings, and subsequent diagnosis of significant CAD.

Conclusion

These findings suggest that reduced heart rate variability is associated with not being married and may contribute to the reliably observed relationship between marital status and cardiovascular disease morbidity and mortality.

Keywords

Marital status Heart rate variability Cardiovascular disease Social support 

Notes

Acknowledgments

This research was supported by the British Heart Foundation (grants RG/05/006 and FS/07/025).

References

  1. 1.
    House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988; 241: 540–545.CrossRefPubMedGoogle Scholar
  2. 2.
    Lett HS, Blumenthal JA, Babyak MA, Strauman TJ, Robins C, Sherwood A. Social support and coronary heart disease: Epidemiologic evidence and implications for treatment. Psychosom Med. 2005; 67: 869–878.CrossRefPubMedGoogle Scholar
  3. 3.
    Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: The national longitudinal mortality study. Ann Epidemiol. 2000; 10: 224–238.CrossRefPubMedGoogle Scholar
  4. 4.
    Joung IMA. Marital status and health problems. In: Fink G, ed. Encyclopaedia of stress. 2nd ed. New York: Academic; 2007: 653–659.Google Scholar
  5. 5.
    Horsten M, Mittleman MA, Wamala SP, Schenck-Gustafsson K, Orth-Gomer K. Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Coronary Risk Study. Eur Heart J. 2000; 21: 1072–1080.CrossRefPubMedGoogle Scholar
  6. 6.
    Rosengren A, Wilhelmsen L, Orth-Gomer K. Coronary disease in relation to social support and social class in Swedish men: A 15 year follow-up in the study of men born in 1933. Eur Heart J. 2004; 25: 56–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Molloy GJ, Stamatakis E, Randall G, Hamer M. Marital status, gender and cardiovascular mortality: Behavioural, psychological distress and metabolic explanations. Soc Sci Med. 2009; 69: 223–228.CrossRefPubMedGoogle Scholar
  8. 8.
    Burman B, Margolin G. Analysis of the association between marital relationships and health problems: An interactional perspective. Psychol Bull. 1992; 112: 39–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Goldman N. Marriage selection and mortality patterns: Inferences and fallacies. Demography. 1993; 30: 189–208.CrossRefPubMedGoogle Scholar
  10. 10.
    Wu Z, Penning MJ, Pollard MS, Hart R. In sickness and in health: Does cohabitation count? J Fam Issues. 2003; 24: 811–838.CrossRefGoogle Scholar
  11. 11.
    Uchino BN. Social support and health: A review of physiological processes potentially underlying links to disease outcomes. J Behav Med. 2006; 29: 377–387.CrossRefPubMedGoogle Scholar
  12. 12.
    Orth-Gomer K, Rosengren A, Wilhelmsen L. Lack of social support and incidence of coronary heart disease in middle-aged Swedish men. Psychosom Med. 1993; 55: 37–43.PubMedGoogle Scholar
  13. 13.
    Brummett BH, Mark DB, Siegler IC, et al. Perceived social support as a predictor of mortality in coronary patients: Effects of smoking, sedentary behavior, and depressive symptoms. Psychosom Med. 2005; 67: 40–45.CrossRefPubMedGoogle Scholar
  14. 14.
    Molloy GJ, Hamer M, Randall G, Chida Y. Marital status and cardiac rehabilitation attendance: A meta-analysis. Eur J Cardiovasc Prev Rehabil. 2008; 15: 557–561.CrossRefPubMedGoogle Scholar
  15. 15.
    Molloy GJ, Perkins-Porras L, Strike PC, Steptoe A. Social networks and partner stress as predictors of adherence to medication, rehabilitation attendance, and quality of life following acute coronary syndrome. Health Psychol. 2008; 27: 52–58.CrossRefPubMedGoogle Scholar
  16. 16.
    Umberson D. Gender, marital status and the social control of health behavior. Soc Sci Med. 1992; 34: 907–917.CrossRefPubMedGoogle Scholar
  17. 17.
    Kessler R, Essex M. Marital status and depression: The importance of coping resources. Soc Forces. 1982; 61: 484-507.CrossRefGoogle Scholar
  18. 18.
    Brummett BH, Babyak MA, Barefoot JC, et al. Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: A prospective study. Psychosom Med. 1998; 60: 707–713.PubMedGoogle Scholar
  19. 19.
    Frasure-Smith N, Lesperance F, Gravel G, et al. Social support, depression, and mortality during the first year after myocardial infarction. Circulation. 2000; 101: 1919–1924.PubMedGoogle Scholar
  20. 20.
    Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: A meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006; 27: 2763–2774.CrossRefPubMedGoogle Scholar
  21. 21.
    Task Force of the European Society of Cardiology and the North American Society of Pacing Electrophysiology. Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. Circulation. 1996; 93: 1043–1065.Google Scholar
  22. 22.
    Houle M, Billman G. Low-frequency component of the heart rate variability spectrum: A poor marker of sympathetic activity. Am J Physiol Heart Circ Physiol. 1999; 276: 215–223.Google Scholar
  23. 23.
    Taylor J, Carr D, Myers C, Eckberg D. Mechanisms underlying very-low-frequency RR interval oscillations in humans. Circulation. 1998; 9: 547–555.Google Scholar
  24. 24.
    Gerritsen J, Dekker T, Ten Voorder B, Kostense P, Heine R, Bouter L. Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease—the Hoom study. Diabetes Care. 2001; 24: 1793–1798.CrossRefPubMedGoogle Scholar
  25. 25.
    Tsuji H, Venditti FJ, Manders ES, et al. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation. 1994; 90: 878–883.PubMedGoogle Scholar
  26. 26.
    Huikuri H, Jokinen V, Syvanne M, et al. Heart rate variability and progression of coronary arteriosclerosis. Arterioscler Thromb Vasc Biol. 1999; 19: 1975–1985.Google Scholar
  27. 27.
    La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet. 1998; 351: 478–484.CrossRefPubMedGoogle Scholar
  28. 28.
    Bigger JT, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation. 1992; 85: 164–171.PubMedGoogle Scholar
  29. 29.
    Liao D, Cai J, Rosamond WD, et al. Cardiac autonomic function and incident coronary heart disease: A population-based case-cohort study: The ARIC study. Am J Epidemiol. 1997; 145: 696–706.PubMedGoogle Scholar
  30. 30.
    Thayer JF, Lane RD. The role of vagal function in the risk for cardiovascular disease and mortality. Biol Psychol. 2007; 74: 224–242.CrossRefPubMedGoogle Scholar
  31. 31.
    Rottenberg J. Cardiac vagal control in depression: A critical analysis. Biol Psychol. 2007; 74: 200–211.CrossRefPubMedGoogle Scholar
  32. 32.
    Dishman R, Nakamura Y, Garcia M, Thompson R, Dunn A, Blair S. Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. Int J Psychophysiol. 2000; 37: 121–133.CrossRefPubMedGoogle Scholar
  33. 33.
    Friedman BH, Thayer JF. Autonomic balance revisited: Panic anxiety and heart rate variability. J Psychosom Res. 1988; 44: 133–151.CrossRefGoogle Scholar
  34. 34.
    Bhattacharyya MR, Whitehead DL, Rakhit R, Steptoe A. Depressed mood, positive affect, and heart rate variability in patients with suspected coronary artery disease. Psychosom Med. 2008; 70: 1020–1027.CrossRefPubMedGoogle Scholar
  35. 35.
    Grippo AJ, Lamb DG, Carter CS, Porges SW. Social isolation disrupts autonomic regulation of the heart and influences negative affective behaviors. Biol Psychiatry. 2007; 62: 1162–1170.CrossRefPubMedGoogle Scholar
  36. 36.
    Horsten M, Ericson M, Perski A, Wamala SP, Schenck-Gustafsson K, Orth-Gomer K. Psychosocial factors and heart rate variability in healthy women. Psychosom Med. 1999; 61: 49–57.PubMedGoogle Scholar
  37. 37.
    Beck A, Steer R, Garbin M. Psychometric properties of the beck depression inventory—25 years of evaluation. Clin Psychol Rev. 1988; 8: 77–100.CrossRefGoogle Scholar
  38. 38.
    Ziegelstein RC, Fauerbach JA, Stevens SS, Romanelli J, Richter DP, Bush DE. Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med. 2000; 160: 1818–1823.CrossRefPubMedGoogle Scholar
  39. 39.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67: 361–370.CrossRefPubMedGoogle Scholar
  40. 40.
    Herrmann C. International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results. J Psychosom Res. 1997; 42: 17–41.CrossRefPubMedGoogle Scholar
  41. 41.
    Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Medical Care. 1992; 30: 473–483.CrossRefPubMedGoogle Scholar
  42. 42.
    Ware J, Kosinski M, Keller S. SF-36 physical and mental health summary scales: A user manual. Boston: The Health Institute; 1994.Google Scholar
  43. 43.
    Brown N, Melville M, Gray D, et al. Quality of life four years after acute myocardial infarction: Short form 36 scores compared with a normal population. Heart. 1999; 81: 352–358.PubMedGoogle Scholar
  44. 44.
    Togo F, Kiyono K, Struzik ZR, Yamamoto Y. Unique very low-frequency heart rate variability during deep sleep in humans. IEEE Trans Biomed Eng. 2006; 53: 28–34.CrossRefPubMedGoogle Scholar
  45. 45.
    Troxel W, Buysse D, Hall M, Matthews K. Marital happiness and sleep disturbances in a multi-ethnic sample of middle-aged women. Behavioral Sleep Medicine. 2009; 7: 2–19.CrossRefPubMedGoogle Scholar
  46. 46.
    Ohayon M. Epidemiology of insomnia: What we know and what we still need to learn. Sleep Med Rev. 2002; 6: 97–111.CrossRefPubMedGoogle Scholar
  47. 47.
    Williams K, Umberson D. Marital status, marital transitions, and health: A gendered life course perspective. Journal of Health & Social Behavior. 2004; 45: 81–98.CrossRefGoogle Scholar
  48. 48.
    Hu YR, Goldman N. Mortality differentials by marital status: An international comparison. Demography. 1990; 27: 233–250.CrossRefPubMedGoogle Scholar
  49. 49.
    Nolan J, Batin PD, Andrews R, et al. Prospective study of heart rate variability and mortality in chronic heart failure: Results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation. 1998; 98: 1510–1516.PubMedGoogle Scholar
  50. 50.
    Eaker ED, Sullivan LM, Kelly-Hayes M, D’Agostino RB Sr, Benjamin EJ. Marital status, marital strain, and risk of coronary heart disease or total mortality: The Framingham offspring study. Psychosom Med. 2007; 69: 509–513.CrossRefPubMedGoogle Scholar
  51. 51.
    Kiecolt-Glaser J, Newton T. Marriage and health: His and hers. Psychol Bull. 2001; 127: 472–503.CrossRefPubMedGoogle Scholar
  52. 52.
    Ditzen B, Neumann I, Bodenmann G, et al. Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroendocrinology. 2007; 32: 565–574.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2009

Authors and Affiliations

  • Gemma Randall
    • 1
  • Mimi R. Bhattacharyya
    • 1
  • Andrew Steptoe
    • 1
  1. 1.Department of Epidemiology and Public HealthUniversity College LondonLondonUK

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