Love, Marriage, And Medicine: A Look At How Our Relationships Influence Our Health

Love, Marriage, And Medicine: A Look At How Our Relationships Influence Our Health

I was making my rounds at the hospital when I was called for a consultation with a patient. I was asked to see a 56-year-old woman with chest pain, whom I'll call Jane. After quickly reviewing the chart, I noticed her cardiac enzymes were elevated; the troponin level, which is a heart muscle enzyme, was several times the upper limit of normal. This was confirmation of heart muscle damage. Unlike some of the other consults I had received, this wasn't a false alarm... Jane actually had a heart attack.

I walked into the room and introduced myself. We began discussing the symptoms that brought Jane to the hospital. She shared with me that she had an intense argument with her husband when she began to experience severe chest pain. Her pain radiated into her arms and was associated with shortness of breath. An ambulance was called, and she was brought to the emergency room. Jane was evaluated in the ER at which point her chest pain resolved; however, her EKG returned abnormal.

After a discussion with Jane detailing the risks and benefits, we decided to proceed with coronary angiography. We took pictures of Jane's arteries which did not demonstrate any evidence of blockage. A ventriculogram was performed to image the main pumping chamber of the heart. Jane's left ventricle was displaying an abnormal pattern of contraction. We had secured our diagnosis. Jane had Takotsubo cardiomyopathy, commonly known as broken heart syndrome. Jane was given reassurance that her coronary arteries were normal. She was given medical therapy and was discharged to follow up in the office. Several weeks later, repeat imaging showed that her heart function had normalized. We focused on stress reduction and lifestyle changes to prevent any recurrent cardiac events.

Takotsubo cardiomyopathy is felt to be related to psychological stress. The exact mechanism is poorly understood. It is thought that there is a release of stress hormones, called catecholamines, in the body which then affect the heart muscle mimicking a true heart attack. Jane's cardiac event was triggered by psychological stress; it was clear that her marriage had a lot to do with it.

There is an interesting connection between marriage and health. Here's what we know... and don't know:

1. Marriage appears to be associated with protection against cardiovascular disease and mortality.
   An article published in the Journal of the American Heart Association (Schultz et al. 2017) suggested that marital status is associated independently with cardiovascular outcomes in patients with high-risk of coronary disease. Specifically compared with married participants, being unmarried is associated with an increased risk of mortality and cardiovascular death. It seems marriage is protective when it comes to health, however it's not that simple.
   
   
2. Even more important than marital status is quality of marriage.
   A study published (Orth-Gomer et al. 2000) suggested that marital stress worsens prognosis in women with coronary heart disease. The study followed 292 women who were hospitalized with heart attacks or coronary syndromes. In the study marital stress was associated with a 2.9 fold increased risk in coronary events after adjustment for other variables. In a separate study of heart failure patients, marital quality predicts survival over the next eight years. (Coyne et al. 2006).
   
   
3. The mechanisms by which our emotional health and physical health can be affected by marriage and relationships are not completely understood.
   Healthy marriage may facilitate social support which is known to be one mechanism of resilience to stress. Social support appears to provide protection against the full impact of mental and physical illness (Ozbay et al. 2007). Marriage may be protective for other reasons. Patients in healthy marriages may be more likely to take their medications or follow up with office appointments. Marriage may also facilitate earlier diagnosis. For example, married men with chest pain may seek medical attention earlier than unmarried men (Atzema et al. 2011).
   
   Sleep is another important factor. Patients with healthy marriages tend to have healthier sleep patterns than patients in unhealthy marriages (Chen et al. 2016). It's also quite possible that it's not marriage itself that confers health benefits. The association between marriage and improved health may be related to specific favorable character traits. People who are married may be more likely to eat healthy or exercise. Conversely, those dealing with severe depression, anxiety, aggression, or other challenges may be less likely to form strong interpersonal relationships.
   
   

A growing body of literature suggests that a healthy marriage promotes longevity. High marital stress increases the risk of cardiovascular events. We also know that the quality of marriage matters. There are many reasons to strive towards maintaining a healthy marriage... it turns out good health may be one.