Association of marital status with takotsubo syndrome (broken heart syndrome) among adults in the United States

Duke Appiah; Rachel Farias; Dena Helo; Linda Appiah; Olugbenga A Olokede; Chike C Nwabuo; Nandini Nair

doi:10.4330/wjc.v13.i8.340

Association of marital status with takotsubo syndrome (broken heart syndrome) among adults in the United States

World J Cardiol. 2021 Aug 26;13(8):340-347. doi: 10.4330/wjc.v13.i8.340.

Authors

Duke Appiah¹, Rachel Farias², Dena Helo², Linda Appiah³, Olugbenga A Olokede², Chike C Nwabuo⁴, Nandini Nair⁵

Affiliations

¹ Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States. duke.appiah@ttuhsc.edu.
² Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States.
³ College of Education, Texas Tech University, Lubbock, TX 79409, United States.
⁴ Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, United States.
⁵ School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States.

Abstract

Background: The pathophysiology of takotsubo syndrome (TTS) is not well understood, however, it is often precipitated by psychological or physical stress. Marital status is related to emotional stress, but its associations with TTS are limited.

Aim: To explored the potential association between marital status and TTS.

Methods: We conducted a case-control study using data on patients aged ≥ 40 years with marital status data in the National Hospital Discharge Survey (2006-2010). The International Classification of Diseases Ninth Revision codes were used to identify cases with TTS and other comorbid conditions. Each case was matched to 5 controls by age, sex, year of TTS diagnosis and bed size of hospital. Two sets of controls were selected: Acute myocardial infarction (AMI) controls and non-cardiovascular disease (CVD) controls. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association of marital status with TTS.

Results: The 59 patients with TTS who had information on marital status were matched to 295 controls with AMI and 295 non-CVD controls, resulting in a sample of 649 patients. The average age of cases was 69.7 ± 11 years with 90% being women and 88% reporting White race. In multivariable-adjusted models, compared to singles, patients who were married had lower odds of TTS (OR = 0.86, 95%CI: 0.79-0.93) while those who were widowed (OR = 1.14, 95%CI: 1.05-1.23) or divorced/separated (OR = 1.32, 95%CI: 1.21-1.45) had elevated odds for TTS when compared to non-CVD controls. Similar results were observed when cases were compared to controls with AMI.

Conclusion: In this study, being married was associated with lower odds for TTS while being divorced/separated or widowed was related to elevated odds for TTS. These novel findings that underscore the potential importance of social factors like marital status in the development of TTS need confirmation in larger studies.

Keywords: Case-control; Epidemiology; Marital status; Marriage; Stress-induced cardiomyopathy; Takotsubo syndrome.