Marital Status and Outcomes in Patients With Cardiovascular Disease.
Marital Status and Outcomes in Patients With Cardiovascular Disease.
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心血管疾病患者的婚姻状况和结局。
DOI：
10.1161/jaha.117.005890
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发表时间：
2017-12-20
影响因子：
5.4
通讯作者：
Quyyumi AA
中科院分区：
文献类型：
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作者：
Schultz WM;Hayek SS;Samman Tahhan A;Ko YA;Sandesara P;Awad M;Mohammed KH;Patel K;Yuan M;Zheng S;Topel ML;Hartsfield J;Bhimani R;Varghese T;Kim JH;Shaw L;Wilson P;Vaccarino V;Quyyumi AA
在一般人群中，未婚与生存率下降有关。已婚、离婚、分居、丧偶或未婚状态是否影响心血管疾病患者的结局尚未得到很好的表征。对6051例因疑似或确诊的冠状动脉疾病而接受心导管插入术的患者（平均年龄63岁，64%为男性，23%为黑人）的前瞻性队列（起始期2003-2015年）进行了中位3.7年（四分位距：1.7-6.7年）的随访。婚姻状况分为已婚（n=4088）与未婚（n=1963），其中包括从未结婚（n=451），离婚或分居（n=842），或丧偶（n=670）。婚姻状况与心血管死亡和心肌梗死的主要结局之间的关系采用根据临床特征调整的考克斯回归模型进行研究。1085例（18%）全因死亡，688例（11%）心血管相关死亡，272例（4.5%）心肌梗死事件。与已婚受试者相比，未婚与全因死亡（风险比[HR]：1.24; 95%置信区间[CI]，1.06-1.47）、心血管死亡（HR：1.45; 95% CI，1.18-1.78）和心血管死亡或心肌梗死（HR：1.52; 95% CI，1.27-1.83）的风险较高相关。与已婚受试者相比，离婚或分居（HR：1.41; 95% CI，1.10-1.81）、丧偶（HR：1.71; 95% CI，1.32-2.20）或从未结婚（HR：1.40; 95% CI，0.97-2.03）的受试者心血管死亡或心肌梗死的增加相似。在调整药物和其他社会经济因素后，这些发现仍然存在。婚姻状况与患有心血管疾病或心血管疾病高风险患者的心血管结局独立相关，未婚人群的死亡率较高。导致这种风险增加的机制需要进一步研究。
Being unmarried is associated with decreased survival in the general population. Whether married, divorced, separated, widowed, or never‐married status affects outcomes in patients with cardiovascular disease has not been well characterized. A prospective cohort (inception period 2003–2015) of 6051 patients (mean age 63 years, 64% male, 23% black) undergoing cardiac catheterization for suspected or confirmed coronary artery disease was followed for a median of 3.7 years (interquartile range: 1.7–6.7 years). Marital status was stratified as married (n=4088) versus unmarried (n=1963), which included those who were never married (n=451), divorced or separated (n=842), or widowed (n=670). The relationship between marital status and primary outcome of cardiovascular death and myocardial infarction was examined using Cox regression models adjusted for clinical characteristics. There were 1085 (18%) deaths from all causes, 688 (11%) cardiovascular‐related deaths, and 272 (4.5%) incident myocardial infarction events. Compared with married participants, being unmarried was associated with higher risk of all‐cause mortality (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.06–1.47), cardiovascular death (HR: 1.45; 95% CI, 1.18–1.78), and cardiovascular death or myocardial infarction (HR: 1.52; 95% CI, 1.27–1.83). Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated (HR: 1.41; 95% CI, 1.10–1.81), widowed (HR: 1.71; 95% CI, 1.32–2.20), or never married (HR: 1.40; 95% CI, 0.97–2.03). The findings persisted after adjustment for medications and other socioeconomic factors. Marital status is independently associated with cardiovascular outcomes in patients with or at high risk of cardiovascular disease, with higher mortality in the unmarried population. The mechanisms responsible for this increased risk require further study.