What are the best ways to avoid heart disease and live a long, healthy life?  The answer starts with the four basic characteristics of a healthy lifestyle: get adequate exercise, maintain a healthy weight, avoid smoking and eat a prudent diet.  Essentially following these four pillars is an individual choice: whether to exercise and how much to exercise, whether to avoid smoking and keep the pounds off and what one eats is largely up to each individual. What can be done beyond the individual? Does marital status affect the heart? Does belonging to a larger community and socializing help prevent heart disease?

It turns out that being married is good for the heart. In patients who have heart disease, being married was better than not being married.  In studies it was found that unmarried participants (including divorced, separated, widowed and never-married) had a 52% higher rate of heart attack and death compared to married participants.  Married patients who had open-heart surgery or stent placement were much more likely to be alive and free from heart events than unmarried patients.  Divorce has the highest rates of heart events and cardiac death, presumably due to the stress it invokes. Fortunately, remarriage decreases some of that risk.  The risk for unmarried patients is the same for both men and women but younger patients (aged < 65 years old) had a higher risk than older patients.  Does the same relationship hold true in the general population (in people who don’t already have heart disease)? In this population as well, unmarried participants had higher rates of heart disease, stroke and death. Why is being married so protective? There are many potential reasons. Having a spouse may mean that warning symptoms are detected and acted upon sooner. Unmarried patients typically had longer delays in seeking treatment. Spouses can encourage sticking to a healthy lifestyle including eating better, having someone to walk or exercise with and providing support when quitting smoking. In addition, spouses can encourage adherence to treatment including taking medications as prescribed. Lastly, the loss of a spouse (either due to death or divorce) has detrimental physical and emotional consequences.  Stress can worsen blood pressure, raise cholesterol, worsen diabetes and accelerate the progression of blockage in the heart arteries.  Stress affects emotional well being resulting in a decreased ability to prevent, detect or treat illness.

The research noted above looked at married versus unmarried people, but it can be generalized to living with someone versus living alone. Can this be broadened further to mean that social isolation is bad for the heart? Is it better to be part of a larger community?  Studies have shown that those with few social contacts (or who are socially isolated) have about 30% higher risk for heart disease and stroke.  In addition, those with poor social connections had a 50% higher risk for death than those with better social integration. This makes the effect of social isolation as detrimental as a sedentary lifestyle or being obese.  Depth and quality of the social connections matter as well.  Having one friend beats being alone, but having a larger network is better and having true friends (as opposed to acquaintances) who can provide emotional support is better still.  Social networks can help when someone is ill, for example by helping to prepare meals or drive to a doctor’s appointment. A connected, supportive network is an antidote to the stress of daily life by providing emotional support and lowering the release of stress hormones. People who are socially isolated tend to engage in negative health behaviors such as smoking, drinking excess alcohol and not exercising or eating correctly. Social isolation also can affect the body by increasing inflammation, decreasing immune function and increasing blood pressure. Lastly, there is no down side to developing a strong social network.  

As the New Year dawns and resolutions are made to follow a healthy lifestyle, don’t forget to include a promise to be part of a healthy community as well. This can be done by joining a walking group, being part of a religious organization or playing on a sports team.  For heart patients, the individual and the community are nicely tied together in the Ornish Lifestyle Medicine Program, which has been shown to reverse the progression of heart disease. The program entails a cohort of ten people who exercise together, eat a heart healthy diet together, and learn how to reduce stress. These patients have similar heart problems so there is a strong component of socialization and social support in the group. Similarly, in cultures known for their longevity, food, exercise and socializing are tied together.  Entire towns are out walking before or after the evening meal. Both the walking and the meal are shared with others in the community. So, grab your spouse or a friend, go for a walk, meet others for dinner, catch a show or a movie and have a wonderful date night.