Can a Happy Marriage Protect Against Heart Disease?

As a primary care physician treating individuals and families in a community setting, I see firsthand how social interactions with an intimate partner—marriage being a prime example—affects health over the lifespan. In older patients, this difference is stark, particularly in my male patients. Single older men fare poorly compared to married older men in both scientific studies and in my medical practice. 

Heart disease–including heart attack and congestive heart failure–is the number one killer in the United States. In 2023, over 680,000 US deaths were caused by heart disease. Statin medications (e.g. atorvastatin, rosuvastatin, simvastatin) have been available here for decades to reduce the risk of heart related death and disability. Multiple, large scale clinical studies contain robust evidence that statins save lives. 

Historically, multiple risk factors–including smoking, high blood pressure and diabetes–have been identified as contributors to heart disease mortality. What is less known and less discussed, at least from a medical perspective, are the social, emotional, and psychological protective factors found in healthy marriage relationships that may, in fact, mediate cardiovascular mortality risk. The question naturally arises: which is better, being married or taking a statin to prevent heart disease?  

Multiple studies show protective health benefits in married couples compared to unmarried individuals. The Centers for Disease Control cites large-scale data that show a clear pattern: Married individuals generally have lower death rates from any cause (like heart attack, cancer, suicide, cancer, pneumonia, etc.) and better physical health outcomes than those who aren’t married.

In a 2020 meta-analysis that included over 7.8 million people worldwide of all ages, cultures, languages, and beliefs, being unmarried was associated with a higher risk of dying from any cause for both men and women (46% higher mortality risk for unmarried men and 22% higher for unmarried women, compared to married peers)​. 

Marriage’s biggest impact seems to show up in conditions like heart disease. For example, a study of over 94,000 people found that never-married men had over three times the risk of dying from cardiovascular disease compared to married men, and nearly double the risk of death from all causes​. 

Marriage’s biggest health impact seems to show up in conditions like heart disease.

Comparing marital status to statin use, a study published by Taylor in the Cochrane Database of Systematic Reviewsfound that regular statin use lowered the relative risk of heart disease death by 20-25% in high-risk individuals. A large-scale study from the National Longitudinal Mortality Study (NMLS) revealed that married adults were 25-60% less likely to die of heart disease than unmarried individuals. A follow-up study in 2016 revealed that the odds of dying from heart disease were between 30% and 70% lower in married couples compared to their unmarried counterparts. The authors concluded, 

After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. 

Therefore, married people may potentially derive more cardiovascular benefit than unmarried people taking a statin. 

Does this mean that simply being married works better than the statin prescribed by a physician? No. We do not advise disregarding sound medical advice regarding statins and heart disease. 

What we do recommend is for patients, doctors, and medical researchers alike to appreciate the potentially unrecognized social and psychological marital factors—such as feelings of caring and being cared for, sharing intimate moments together, shared meaning and purpose, reminders for each other to take medications and avoid unhealthy habits —that help improve heart outcomes. 

Additionally, it is important to note that being married in and of itself is not much of a protective factor alone. Married couples who rate themselves as “unhappy” in the relationship have significantly worse outcomes compared to those who rate themselves as “happy”. 

We invite the scientific community and individuals with or at risk for heart disease to emphasize healthy, thriving marriage relationships, along with other diet and lifestyle changes, in addition to statin drugs, to further prevent heart-related deaths and disability. 

Scott Hastings, D.O. is a board-certified family doctor in Frisco, Texas. He is the founder and medical director of Family Medicine Plus and 7 Health, a direct primary care organization. Together with his wife Heidi, they co-host the popular "Marriage IQ" podcast.