A new prospective cohort study shows that negative aspects of a
close relationship--such as not confiding and not getting emotional
support--can increase the risk of coronary events [1]. Dr Roberto De
Vogli (University College, London, UK) and colleagues report their
findings in the October 8, 2007 issue of the Archives of Internal
Medicine.

"We think the quality of social relationships can be a very
important factor for health and well-being," epidemiologist De Vogli
told heartwire. "There is a growing body of literature that shows
that being exposed to negative relationships that increase worry,
anxiety, and feelings of low self-esteem can in the long term
produce emotional effects that may trigger biological changes in the
body."

De Vogli said poor marital quality has previously been reported as
an important prognostic factor for MI, heart failure, and metabolic
syndrome and that women seem to be more affected by the negative
aspects of a close relationship than men. "Our findings expand and
corroborate previous research . . . by showing that negative
interactions in close relationships are determinants of coronary
events."

Negative aspects of relationship up CHD risk by 34%

De Vogli and colleagues prospectively studied 9011 British civil
servants (6114 men and 2897 women) and assessed negative aspects of
close relationships and other social-support measures with a
questionnaire. Of the respondents, 80% cited marriage or a
partnership as their closest relationship.

Associations between negative aspects of relationships and coronary
events were determined during an average of 12.2 years of follow-up.
The researchers set out with the preconception that the association
would be stronger among women and among people of lower social
position, based on previous work in this field.

Of the 8499 individuals who did not have coronary heart disease
(CHD) at the beginning of the study and who provided sufficient
information for analysis, 589 reported a CHD event.

After adjustment for a number of factors, including
sociodemographic, biological (obesity, hypertension, diabetes, and
cholesterol levels), and health behaviors (smoking, alcohol intake,
exercise, and fruit and vegetable consumption), they found that
people who experienced negative aspects of a close relationship had
a 34% higher risk of incident coronary events (hazard ratio 1.34;
95% CI 1.10-1.63) than those who did not.

The association was attenuated but remained significant after
additional adjustment for negative affectivity and depression (HR
1.25).

Contrary to their prior hypothesis, they found that although women
and people in a lower employment grade were more likely to be
exposed to negative aspects of a close relationship, sex and social
position had no significant interaction effects.

This shows that negative interactions in close
relationships "produce similar effects on heart disease regardless
of sex and social position," the researchers say.

"Be nicer to each other"

De Vogli et al go on to suggest that negative close relationships
may be more powerful predictors of health than other aspects of
social support because previous research indicates that "individuals
tend to mentally replay negative encounters more than they replay
positive ones."

De Vogli told heartwire that he believes emotional effects could
trigger changes in the neuroendocrine, inflammatory, and
immunomodulatory systems. And although pharmacological
approaches "may cure the symptoms, they are just responding to the
crisis and not tackling the root causes," he said. Increasing
pressures in society, evidenced by the stresses seen in children
these days, also contribute to negative aspects of relationships.

"People just need to be nicer to each other," he says. "It seems so
simple, but it's basically a truism."

De Vogli R, Chandola T, and Marmot MG. Negative aspects of close
relationships and heart disease. Arch Intern Med 2007; 167:1951-1957.