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People with Bad Personal Relationships Have a 34% Increased Risk for Coronary Heart Disease

Posted: Thursday, October 18, 2007

A new prospective cohort study shows that negative aspects of a close relationship--such as not confiding and not getting emotional support--can increase the risk of coronary events for both men and women.

Epidemiologist De Vogli stated that, "We think the quality of social relationships can be a very important factor for health and well-being and that there is a growing body of literature that shows that being exposed to negative relationships that increase worry, anxiety, and feelings of low self-esteem can in the long term produce emotional effects that may trigger biological changes in the body."

De Vogli said poor marital quality has previously been reported as an important prognostic factor for MI, heart failure, and metabolic syndrome and that women seem to be more affected by the negative aspects of a close relationship than men. "Our findings expand and corroborate previous research . . . by showing that negative interactions in close relationships are determinants of coronary events."

De Vogli and colleagues prospectively studied 9011 British civil servants (6114 men and 2897 women) and assessed negative aspects of close relationships and other social-support measures with a questionnaire. Of the respondents, 80% cited marriage or a partnership as their closest relationship.

Associations between negative aspects of relationships and coronary events were determined during an average of 12.2 years of follow-up. The researchers set out with the preconception that the association would be stronger among women and among people of lower social position, based on previous work in this field.

Of the 8499 individuals who did not have coronary heart disease (CHD) at the beginning of the study and who provided sufficient information for analysis, 589 reported a CHD event.

After adjustment for a number of factors, including sociodemographic, biological (obesity, hypertension, diabetes, and cholesterol levels), and health behaviors (smoking, alcohol intake, exercise, and fruit and vegetable consumption), they found that people who experienced negative aspects of a close relationship had a 34% higher risk of incident coronary events (hazard ratio 1.34; 95% CI 1.10-1.63) than those who did not.

The association was attenuated but remained significant after additional adjustment for negative affectivity and depression (HR 1.25).

Contrary to their prior hypothesis, they found that although women and people in a lower employment grade were more likely to be exposed to negative aspects of a close relationship, sex and social position had no significant interaction effects.

This shows that negative interactions in close relationships "produce similar effects on heart disease regardless of sex and social position," the researchers say.

De Vogli went on to suggest that negative close relationships may be more powerful predictors of health than other aspects of social support because previous research indicates that "individuals tend to mentally replay negative encounters more than they replay positive ones."

De Vogli believes emotional effects could trigger changes in the neuroendocrine, inflammatory, and immunomodulatory systems. And although pharmacological approaches "may cure the symptoms, they are just responding to the crisis and not tackling the root causes," he said. Increasing pressures in society, evidenced by the stresses seen in children these days, also contribute to negative aspects of relationships.

"People just need to be nicer to each other," he says. "It seems so simple, but it's basically a truism."

Source: Diabetes In Control: Arch Intern Med Oct. 2007; 167:1951-1957. De Vogli R, Chandola T, and Marmot MG. Negative aspects of close relationships and heart disease.