According to the research gathered in book The Case for Marriage by Waite and Gallagher, enjoying your adult life in the bosom of a healthy marriage improves positive feelings of well-being, decreases loneliness, reduces emotional distress, offers a more satisfying sexual life, keeps you physically healthier and enhances your financial condition.   Still, who would have thought that getting and staying married could lower your risk of heart attacks! 

Here’s why.

How do we know that being married really can lower the likelihood that a person will have a heart attack?

A recent study in Finland led by researcher Dr. Aino Lammintausta of Turku University Hospital found that men and women who were married had fewer acute coronary episodes.  Published in the European Journal of Preventive Cardiology, this Finnish study followed more than 15,300 people to arrive at these conclusions.  

Both men and women were at increased risk for heart attacks if they were single than if they were living within the protective cocoon of a marriage. 

---Unmarried men were 58 percent to 66 percent more likely to have a heart attack that those who lived with a spouse. 

---For women the difference in heart attack risk for singles versus marrieds was similarly high.  Single women were 60 percent to 65 percent more likely to suffer a heart attack than their married peers.

The study's conclusion?  When it comes to heart problems, marriage makes a real health difference.

 What about risks of dying if there is a heart attack?

The statistics in the Finnish study are even more startling here. That is, even though your odds are lower that you will have a coronary event if you are married, some married people still will have one.  What then?

If a person does have a heart attack, survival rates are better for married folks as compared with their single peers. Married men were significantly less likely to die if a heart problem did occur, that is, were more likely to live to see another day, than their unmarried counterparts.   And for women, the protective impacts of marriage were even more potent.  

What is it about being married that helps, both with heart attack prevention?

While multiple studies of many types of illnesses, married people consistently score with better physical health, it's unclear which of multiple factors account for the outcomes.   Maybe it’s the healthier meals that people living together tend to eat.  Maybe they sleep better.  Maybe it’s because married folks on average tend to earn more money so that they feel less stressed financially.  Maybe it's the companionship factor, that is, someone living with you who generates loving feelings (ooh, that oxytocin!), replacing potential loneliness with connection and mutual caring.

Maybe the health benefits of marriage come from having someone else to keep an eye on you.  A spouse is likely to notice when you have a problem and to suggest and even insist that you go to the doctor when something in your body seems not quite right. 

Maybe the presence of a life partner motivates people to want more strongly to stay healthy.  

How does a spouse help if you do have a heart attack?

On a purely practical level, if you are married, there’s someone there to call an ambulance.  

Professionals often function at a higher level when someone is watching, so once an ambulance gets the patient to an emergency room a spouse who comes along increases the odds that the medical care will be top notch. 

Besides, the spouse can run to get a nurse if a problem occures while the patient is alone resting.  A spouse knows and can give the medical staff key information that may be relevant to the patient’s condition.  A spouse visiting with you in your hospital room can provide an extra set of eyes to double check that the nurses are giving you proper medications and doses. 

These reasons are all hypotheses.  Hopefully further studies eventually will clarify what exactly it is about marriage that makes people more likely to prevent and survive heart attacks. 

Meanwhile however, knowing that marriage can have such an important health impact can serve as extra motivation to keep your marriage strong and loving.

Are there also downsides to marriage and heart health? 

Alas, all good things must come to an end.  At some point, one spouse is likely to "predecease" the other.  Death brings loss, and loss can bring a broken heart for the surviving spouse. 

If your loved one dies, can you die of a broken  heart?

A broken heart turns out to be more than a metaphor.  People who have recently lost a beloved spouse are at increased heart attack risk.

One explanation may lie in the hormones released during moments of extreme stress or shock. Scientists at the University of Amsterdam (Psychological Science, 2010) found that rejection triggers the parasympathetic (relax) nervous system, causing an instant and significant drop in heart rate. Fear experienced during rejection also tends to activate the sympathetic nervous system (fight or flight) which revs up the heart. This stop-and-go effect on the heart could contribute to the sensation of heart breaking.

A small portion of the population, mostly women between 30 and 50 years of age, also may experience a condition called stress-induced cardiomyopathy or takotsubo cardiomyopathy, for which the nickname is heartbreak syndrome. This condition occurs when an over-release of adrenaline in response to an emotional shock causes rapid and severe heart muscle weakness (cardiomyopathy).

The symptoms of heartbreak syndrome are similar to those of a heart attack, including chest pain, shortness of breath, congestive heart failure, and low blood pressure. Typically these symptoms manifest minutes to hours after the person has been exposed to a severe, and especially unexpected, stress.  The condition is not generally fatal. Though in unusually intense situations and with a person with a vulnerable heart it can bring on a death, heartbreak syndrome usually includes no clogging of the arteries like a standard heart attack.  At the same time, it can cause severe short-term heart muscle failure, so medical attention can be important.

When the going gets tough in a marriage, is heart attack risk still lowered by living life in partnership?

The hypothesized protective mechanisms described above would still pertain.  At the same time however, alas, living together as life partners also can prove challenging.  Along with providing friendship, partnership does increase the chances of friction, and irritation and anger generate an increase in heart attack risk. 

Marriage is challenging because living together as life partners requires making shared decisions, being patient with each others’ quirks, and being responsive to each others’ preferences. Not every spouse, alas, has the ability for this kind of responsivity and not every couple has sufficient skills for collaborative problem-solving whether the issue is small, like what to eat for dinner, or large, like how to handle a difficult relative or financial dilemma.

While couples with strong collaborative dialogue and decision-making skills can generally manage these complexities in good humor, couples who develop habits of responding to differences with irritation, anger, or worst of all rage are increasing their odds of heart problems.

Every harsh word, critical voice tone, or unilateral decision made against the wishes of the partner invites the stress hormones like cortisol to surge: cortisol is not good for sustaining a healthy body.  Similarly, depression, likely to arise if one partner feels attacked and caves in rather than being able to interact in an atmosphere of mutual respect and equal empowerment, lowers immune system effectiveness and delays healing. 

Have studies shown that anger in a marriage increases heart attack risk?

Yes, multiple studies have concluded that for all people, anger increases heart attack risk.  For instance, Dr. Elizabeth Mostsofsky’s Harvard School of Public Health study found that during the two hours after an outburst of rage, heart attack risk increases five-fold. 

Marriage can invite anger simply because there is a second person in your environment who could potentially serve as an anger trigger.  If you live with a spouse who is inherently provocative (critical, nasty, demanding, etc) or if you are someone who by nature has trouble adjusting to another person's presence, your frequent angry feelings could spell trouble. 

Holding in anger does not help the odds.  In a Swedish study by Dr. Constanze Leineweber of Stockholm University, men who suppressed their anger rather than raging doubled their risk of a heart attack.

According to a study at Johns Hopkins Medical Institution conducted by Dr. Patricia Chang, being anger-prone increases heart attack risk by three to five times, even for young men with no family history of heart disease.  Whether the quick-to-anger young men expressed their anger, held it in, or let it out in bits and pieces with complaints and irritability, anger-prone young men were vastly more likely than others their age to suffer an early heart attack. 

And, alas, earlier studies have established that being the recipient of anger as well as being the person who rages is bad for health as well, especially for women.

How about depression?  Does depression increase risks of death from a heart attack?

For sure.  While there are many studies confirming this relationship, the following two are especially striking:

---A study performed by Dr. Curt D. Furberg of Wake Forest University found that in 4,500 elderly participants with no history of heart disease, those who showed signs of depression had a 40 percent higher risk of developing coronary disease.

---A­nother study in Baltimore, Md., found that depressed people of all ages are four times more likely that those who do not report depression to have a heart attack in the next 14 years following the study.

What is the bottom line?

A healthy marriage can keep you physically healthy, offering yet another incentive to do all you can to insure that your relationship stays lasting and loving.

In addition, skills for talking over differences cooperatively are worth developing to minimize anger and depression in all your relationships.  For instance, if you feel anger rising, take two steps back, excuse yourself nicely to “go get a drink of water,” breathe deeply, count to ten.  Then, with renewed calmness, return to complete the conversation in a quietly loving way. Likewise, learn to make decisions in a way that enables both of you to count lest you inadvertently trigger depression in your loved one.

Most of all, cherish your spouse, remembering always your vows to love and protect each other.


Denver clinical psychologist Susan Heitler, Ph.D, a graduate of Harvard and NYU, is author of Power of Two, a book, a workbook, and a website that teach the communication skills that sustain positive relationships.  

Click here for a free Power of Two relationship quiz. 

Click the Power of Two logo to learn the skills for a strong, emotionally healthy and loving marriage.

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