Marriage and Heart Health

Many studies confirm this mind-body connection and the observations I have made for years in my own cardiology practice.

Stress is a killer, whether it comes from a job or a relationship.  I've had many patients who worked at the wrong job for years and then had a heart attack. While staring up at the ceiling in intensive care they went through an almost religious catharsis as they realized that the stress of their work put them in the hospital. Likewise, I have had both men and women in intensive care make the same connection about a wrong marriage.

Sometimes it takes a heart attack to make people realize just how powerful stress can be. Some never get to act on their realization. Patients have confessed to me about the stress in their lives, whether it was a job or a marriage, and it eventually killed them. All the advice and medicine and supplements couldn't trump the power of stress.

The opposite of this, obviously, is a harmonious marriage and enjoyable work. Satisfaction protects the heart.

Research tells us the following, and I have certainly seen this at work in my practice:

• Loneliness is a risk factor for heart disease.
• Married people experience less cardiovascular disease than single people, however, a bad marriage can be disastrous to the heart.
• One of the common denominators of longevity-as determined by surveys of people in their eighties and nineties-is a healthy marriage.

One fascinating study in 2006 caught my eye along these very lines. It shed specific light on the dynamics within marriages and how they affect heart health. It was conducted by Tim Smith, a University of Utah psychologist. In his study, Smith recruited one hundred and fifty healthy married couples-most of them in their sixties. None of the participants had a history of cardiovascular disease.

Each couple was interviewed by psychology graduate students and videotaped. The interview was based on a topic the couples chose-such as money, in-laws, children, vacations, and household duties-that caused disagreement in their marriage. The husband and wife then discussed the chosen topic, facing each other, while the camera rolled.

The research team assigned values to the comments indicating the extent to which they were friendly versus hostile, and submissive versus dominant or controlling.

For example, comments like, "You can be so stupid sometimes" or "you're too negative all the time," were rated hostile and dominant. Another dominant or controlling comment would be, "I don't want you to do that; I want you to do this."

According to Smith, some of the discussions were calm and peaceful, but in some cases, quite hostile, even prompting the interviewer to recommend counseling.

The researchers assumed that a couple's behavior during the discussion was like the microcosm of the macrocosm-a snapshot of long-term pattern of behavior, and that probably a marital spat in front of researchers likely represented a muted rendition of what really went on at home.

Two days after these sessions, all participants underwent a special CT scan of the chest in which doctors used a standard scale to score each person's level of coronary artery calcification, an indicator of plaque buildup in the arteries to the heart. Even though none of the atherosclerosis revealed by the scans amounted to a medical emergency, some of the scores were actually high enough to place the individuals at high risk of a coronary event.

The findings were summarized thusly:

• The more hostile the wives' comments during the discussion, the greater the extent of calcification of the arteries. Particularly high levels of calcification were found in "women who behaved in a hostile and unfriendly way and who were interacting with husbands who were also hostile and unfriendly."
• The extent to which either wives or husbands acted in a dominant or controlling manner was unrelated to the severity of calcification in the wives.
• The extent to which wives or husbands spoke with hostility had no relationship to the severity in the husbands.
• Husbands who displayed more dominance or controlling behavior-or whose wives displayed such behavior-were more likely than other men to have more severe calcification.

Smith concluded that either being controlling or being married to someone who is controlling is enough to promote atherosclerosis in men. In couples where there was not a struggle for control, those men had much lower levels of atherosclerosis. 

Smith felt that hostility during marital disputes was bad for women's hearts, while controlling behavior during marital disputes was bad for men's hearts.

"Disagreements are an unavoidable fact of relationships," he said. "But the way we talk during disagreements gives us an opportunity to do something healthy." For spouses concerned about each other, avoid both hostility and controlling behavior during disagreements, he adds.

Fascinating information. Obviously, this is not impeccable science. We don't know other things going on in the lives of these people that could be contributing to calcification, but the study nevertheless sheds some light on how the dynamics of husbands and wives plays out on the stage of cardiovascular disease.

In any case, the bottom line is still the same. Stress has the potential to kill. It is interesting that the more hostile the wives' comments the greater the level of calcification. Many patients of mine have been shocked to hear that they have coronary calcification even though their other risk factors are in good shape.

They want to know, "How did I get this?"
The answer to them is another question: "How much stress do you have in your life?" I've been doing these scans for years. I've had many people with really no physical risk factors for cardiovascular disease but who still have calcification of the arteries just on the basis of stress alone.

Psychological stress causes release of stress hormones-cortisol, adrenalin, epinephrine-and these chemical substances can oxidize cholesterol and make it inflammatory. And then calcium gets laid on as part of the inflammatory process.

The control and dominance issues in this study were fascinating and reminded me of animal experiments in which weaker animals developed atherosclerosis when dominant animals were placed in their presence. In these experiments, mice and hamsters became frightened, excessively vigilant, and then deathly sick after dominant tree shrews were introduced.

Can the same thing happen in a marital relationship? This study was the first time I have seen this evidence in humans. So dominance or control-whether you are shelling it out or receiving it- can be harmful to one heart or the other. In any case, the body is producing stress chemicals and somebody's arteries are suffering as a result.