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Marital Status and SES Associated With Higher Risk of Second Heart Attack, Stroke


Divorce and socioeconomic status (SES)—measured by disposable income and education—predict patients who survived a heart attack who are at higher risk of a second event.

People who survive a heart attack are at higher risk of a second event if they are divorced or have a low socioeconomic status (SES), according to a new study of Swedish patients published in European Journal of Preventive Cardiology.

While previous studies have identified the association between low SES and first heart attack, this new study looked at the risk of a second event.

The researchers analyzed data on 29,226 men and women who had been registered in the secondary prevention quality registry of SWEDEHEART at the standardized 1-year revisit after a first myocardial infarction. SES was measured by disposable income and educational level, and marital status was recorded. Patients were followed for an average of 4 years for the first recurrent event of atherosclerotic cardiovascular disease.

During the follow up, a recurrent event occurred in 7.8% (2284) of participants, and both socioeconomic and marital status were associated with occurrence of an event such as non-fatal heart attack, death from coronary heart disease, fatal stroke, or non-fatal stroke.

“Marriage appears to be protective against recurrent events and aligns with traditional indicators of higher socioeconomic status, but conclusions on the underlying mechanisms cannot be drawn from this study,” study author Joel Ohm, a PhD student at Karolinska Institutet, said in a statement.

The researchers found that the association between disposable income and a recurrent event was stronger in men and among those who were unmarried. In the study, the authors noted that previous research showed that inquiring about family income in a clinical setting can be viewed as an intrusion into privacy, but that the findings of the study support the use of income as an important indicator of SES.

They adjusted for age, sex, and year of first heart attack to find that patients with more than 12 years of education had a 14% lower risk of a second event compared with people who had 9 years of education or fewer. Divorced patients had an 18% greater risk of a recurrent event than married patients.

A subgroup analysis found that unmarried men were at a higher risk of recurrence, while unmarried women were at a lower risk. But Ohm warned that those results “should be interpreted cautiously,” as unmarried women had a higher level of education than unmarried men, and that difference in SES may have an influence on those findings.

“The take-home message from this study is that socioeconomic status is associated with recurrent events,” said Ohm. “No matter the reasons why, doctors should include marital and socioeconomic status when assessing a heart attack survivor’s risk of a recurrent event. More intense treatment could then be targeted to high-risk groups.”


Ohm J, Skoglund PH, Discacciati A, et al. Socioeconomic status predicts second cardiovascular event in 29,226 survivors of a first myocardial infarction. [published online April 17, 2018]. Eur J Prev Cardiol. doi: 10.1177/2047487318766646.

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