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A Stressful Marriage Can Make It Harder to Recover From a Heart Attack

Yale Public Health Magazine, Yale Public Health: Fall 2023
by Jane E. Dee


A study led by researchers at the Yale School of Public Health found that marital stress was associated with worse recovery after a heart attack in people 18-55 who are married or in a relationship, and that the stress may make it more difficult for younger adults to regain their physical and mental health after a heart attack.

Young women are disproportionately vulnerable to the adverse cardiovascular effects of psychological stress.

Identifying marital and relationship stress in young adult patients who have had a heart attack might improve their health outcomes within the first year of recovery, the researchers said.

"Health care professionals need to be aware of personal factors that may contribute to cardiac recovery and focus on guiding patients to resources that help manage and reduce their stress levels," said Cenjing Zhu, PhD ’23, (chronic disease epidemiology), the study's lead author. Judith Lichtman, PhD ’96, MPH ’88, Susan Dwight Bliss Professor of Epidemiology (chronic diseases), is the senior author.

The study, which was funded by a grant from the National Heart, Lung, and Blood Institute (NHLBI), was published in the Journal of the American Heart Association.

Participants were drawn from the NHLBI-funded VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study.

Of the study participants, 36.2% reported severe marital stress, which was more common in female than male participants. Unlike other stressors that are often limited or situational, marital stress can be chronic and ongoing.

Young women are disproportionately vulnerable to the adverse cardiovascular effects of psychological stress and develop mental stress‐induced myocardial infarction four times more often than similarly aged men. Prior research from the VIRGO study also found that young women with acute myocardial infarction (AMI) experienced more depression and overall stress, which was associated with worse outcomes throughout their first year of recovery.

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