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Marital Status, Marital Quality, and Atherosclerotic Burden in Postmenopausal Women

From SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University (L.C.G.), the Department of Psychology (W.M.T.), and the Graduate School of Public Health (L.H.K., K.S.T), University of Pittsburgh, and the Departments of Psychiatry (K.A.M.) and Medicine (D.E.), University of Pittsburgh School of Medicine, Pittsburgh, PA.

Address correspondence and reprint requests to: Karen A. Matthews, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213.

SUMMARY: Marriage confers health benefits for men, but the evidence for women is less consistent. Inconsistent findings may be attributed, in part, to the confounding of marital status and marital quality.

OBJECTIVES: The authors examined whether women in satisfying marriages evidence lesser atherosclerosis relative to women in low-satisfying marriages and relative to unmarried women.

MATERIALS AND METHODS: Three hundred ninety-three women from the Healthy Women Study participated in this study. Marital status and quality were assessed at baseline when women were premenopausal. Cardiovascular risk factors were also assessed at baseline to determine potential mediators. Markers of atherosclerotic burden—B-Mode ultrasound measures of intima-media thickness and plaque in the carotid arteries and electron beam computed tomography assessments of calcification in the aorta and coronary arteries—were performed, on average, 11 years and 14 years later, respectively. A subset of women underwent a second ultrasound scan approximately 3 years after their first scan.

RESULTS: Women in satisfying marriages had the least atherosclerosis in the carotid arteries and aorta, especially relative to those in low-satisfying marriages. Women in satisfying marriages also tended to show less rapid progression of carotid atherosclerosis relative to women in low-satisfying marriages. Women who did not have a partner had intermediate levels of atherosclerosis. Risk factors measured at baseline contributed to the differences between the satisfied and low-satisfied groups, but not those between the satisfied and unmarried groups.

CONCLUSIONS: High-quality marriages may protect against cardiovascular disease for women. Studies concerning marriage and cardiovascular health in women should, therefore, concurrently examine marital quality and marital status.

Key Words: atherosclerosis, • calcification, • marriage, • stress, • ultrasound.

Abbreviations: BMI = body mass index;; DBP = diastolic blood pressure;; CHD = coronary heart disease;; CI = confidence interval;; EBCT = electron beam computed tomography;; HDL-c = high-density lipoprotein cholesterol;; HT = hormone therapy;; HWS = healthy women study;; IMT = intima-media thickness;; LDL-c = low-density lipoprotein cholesterol;; MI = myocardial infarction;; OR = odds ratio;; PP = pulse pressure;; SBP = systolic blood pressure.

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