A bad marriage can break your heart — literally.

Heart attack survivors in a stressful relationship are more likely to have a rocky recovery, a new study reports.

“We found there’s an independent association between severe marital stress and worse outcomes within their first year of recovery,” said lead researcher Cenjing Zhu, a doctoral candidate in chronic disease epidemiology at the Yale School of Public Health.

Compared to people in healthy relationships, heart patients under severe marital stress were 67% more likely to suffer recurring chest pain during the first year of their recovery, Zhu and her colleagues found.

Severe marital stress also increased a person’s chances of rehospitalization by nearly 50%, and affected their quality of life and health.

On a 12-item scale, for example, participants with severe marital stress scored 2.6 points lower in mental health and more than 1.6 points lower in physical health, compared with those reporting little to no stress.

Zhu is scheduled to present the findings Sunday at the American Heart Association’s annual meeting, in Chicago.

The findings shed new light on the nuanced effect that relationships can have on a person’s health, said Dr. Nieca Goldberg, medical director of Atria New York City and a clinical associate professor of medicine at NYU Grossman School of Health.

“Earlier studies on marriage found that people who were couples have better heart health than those who were not in a relationship,” said Goldberg, who wasn’t part of the research. “But this study actually looks at the quality of the relationship, and the severe marital stress going on within couples.”

For the study, Zhu and her colleagues tracked nearly 1,600 U.S. adults ages 18 to 55 who were treated for a heart attack between 2008 and 2012. These folks were located across the nation, and all were either married or in a committed partnership.

Participants completed a 17-item questionnaire designed to assess marital stress, and were placed in three categories — mild or no stress, moderate stress and severe stress. Researchers then followed them for up to a year to see how well they fared.

More women reported marital stress than men. Nearly 4 in 10 women said they had severe marital stress compared to 3 in 10 men.

Patients should “be aware that marital stress in their life could be affecting their recovery,” Zhu said.

People whose relationship stress is affecting their heart attack recovery need to pursue counseling and get “the help they need to lower stress, anxiety or depression,” Goldberg said.

Stress from a bad marriage could affect recovery in a couple of ways, she said.

The tension caused by a bad relationship “certainly has a negative impact on cardiovascular risk factors, particularly with raising blood pressure, making it very difficult with somebody who is very stressed or anxious to follow through on a medical regimen or a lifestyle program,” Goldberg said.

Stress can wreck a person’s energy levels and rob them of the sleep they need to recover, the American Heart Association says. Stress also has been associated with irregular heart rate and rhythm, high blood pressure, digestive problems, inflammation and reduced blood flow to the heart.

Being at odds with a partner also can deny a heart attack patient the support they need during this critical moment in their life, Goldberg added.

“When you’re someone who has had a heart attack, you have to follow a medical regimen, probably change the way you’ve been eating, quit smoking and change your life,” she said. “But that’s a challenge if you’re not in a supportive environment.”

Doctors guiding a heart attack patient through recovery need to consider their mental and emotional health as much as their physical health, Zhu and Goldberg said.

“Our findings really highlight the importance of evaluating everyday stress, because it’s not currently incorporated in routine screening,” Zhu said.

Goldberg agreed.

“It’s really important for clinicians, people caring for the person who had the heart attack, to not only address the traditional risk factors but also be aware of the mental health component in the care of a cardiac patient,” Goldberg said. “Recovery after a heart attack is not only about the things that we can do medically. It’s really time we understand that mental health is connected to our physical health.”

Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

More information

The American Heart Association has more about stress and heart health.

SOURCES: Cenjing Zhu, MPhil, PhD candidate, chronic disease epidemiology, Yale School of Public Health, New Haven, Conn.; Nieca Goldberg, MD, medical director, Atria New York City, and clinical associate professor, medicine, NYU Grossman School of Health, New York City; American Heart Association, news release, Oct. 31, 2022