Death and Marriage in The Big Easy

The Skeptical Cardiologist is not just researching low carb diets in The Big Easy. He has also been investigating the effects of marriage on cardiovascular risk.
I and the significant other of the skeptical cardiologist stayed at the wonderful Terrell House, a  bed and breakfast nestled among the magnolias on Magazine Street in the Garden District of New Orleans. There, we participated in the marriage of our close friends, Dave and Barb.
Was marrying a heart healthy choice for Dave? for Barb?
Science seems to tell us yes. Marriage has been associated with a lower risk of cardiovascular disease compared to being single or divorced in multiple studies and for both sexes.
A study of the rate at which individuals in Finland developed what are termed acute coronary syndromes or ACS (think of these as heart attacks or heart attacks about to happen) showed that ACS events were approximately 58–66% higher among unmarried men and 60–65% higher in unmarried women, than among married men and women in all age groups.
The chance of dying within 28 days of an ACS were even worse for the unmarried. These mortality rates were found to be 60–168% higher in unmarried men and 71–175% higher in unmarried women, than among married men and women.
This meant a rate of death of 26% in the 35-64-year-old married men, 42% in men who had previously been married, and 51% in never-been-married men. Among women, the corresponding figures were 20%, 32%, and 43%.
As with all such observational studies, association does not prove causation.
How on earth does being married confer a lower risk of developing cardiac problems and halving of the death rate once one has an ACS?
Some speculation from the authors:
1.  Perhaps a poor health status leads to not getting married or getting divorced more frequently.
2.  Perhaps married people have better health habits and enjoy higher levels of social support than the unmarried which promotes lower risk
3. Perhaps prospects in the pre-hospital phase are better because of earlier intervention (wife bugging husband to get that indigestion checked out)
Do I believe that Dave and Barb have suddenly halved their risk of dying from cardiovascular disease because they tied the knot last night?  Not at all!
Nothing has fundamentally changed in their lives that I can see that will have any significant impact on either one’s risk of a heart attack.
If Dave were a true bachelor and not in a committed monogamous relationship I can see certain factors that marriage would modify: perhaps unmarried Dave would be more inclined to engage in risky behaviors such as binge drinking, cigarette smoking, unhealthy food consumption or staying out late partying and  listening to wild music. Perhaps married Dave’s wife will be watching over him carefully for any signs or symptoms of heart disease and encouraging an early visit to the doctor to get checked out.
Perhaps the presence of kids limits the married parents engagement in risky or unhealthy behaviors either because the parents are spending more time parenting than partying or because they are trying to serve as role models.
Perhaps, and this is likely unmeasurable, it is the “love” in the relationship (and the associated change in neurohormonal milieu) that lowers stress and inflammation and is crucial in stopping atherosclerosis.
Two individuals living together in a committed and loving relationship would seem to have these same factors on their side and I can’t fathom how the legal or religious sanctioning of their union modifies those factors favorably.
Unfortunately, the myriad studies that have been published on this topic totally fail to capture the important distinction between single and unattached and single but living in a committed and loving relationship.
In any event, in the immortal words from my toast to them last night: