Til Stress Do Us Part: Marriage Angst Can Be Hard On Your Heart

(Neil Moralee/Flickr)

(Neil Moralee/Flickr)

By Alvin Tran
Guest Contributor

Marriage is hard even in the best of circumstances. But new research suggests that if things are particularly hard, the stress can take a toll on your heart — especially if you’re older and female.

In a study published this week in the Journal of Health and Social Behavior, researchers found that older couples in bad marriages have a higher risk for heart disease compared to those in good marriages. This link between the quality of a marriage and the risk of heart-related problems, such as high blood pressure, is even more pronounced among female spouses.

“The strain and stress from the marital relationship has a strong negative effect on people’s heart,” said Hui Liu, an associate professor of sociology at Michigan State University and the study’s lead author. “If the marriage is very stressful, it’s really hard on your heart.”

Liu, along with co-author Linda Waite of the University of Chicago, analyzed data from an ongoing nationally representative project that followed nearly 1,200 older men and women, ages 57 to 85, for a period of five years.

After comparing participants at the beginning of the study to the end of the five-year follow-up period, they found a significant link between an increase in negative marital quality with higher risk of hypertension among women. Not-so-hot marriages were marked by less spousal support and with husbands and wives spending less time with each other.

“The effect of marriage quality on cardiovascular risk is stronger for women than for men. It also becomes stronger as people get older,” Liu said during an interview. “We think marriage is one of the social factors that may affect the risk of cardiovascular disease.” Continue reading

Why To Exercise Today, For Men: High Blood Pressure Hits Much Later

By Alvin Tran
Guest contributor

One out of every three American adults has high blood pressure. And, whether you’re a man or a woman, your blood pressure naturally increases with age, raising your risk of health problems from stroke to heart disease and diabetes.

But there is a silver lining – at least for men with higher fitness levels, a new study finds.

The study, published in the Journal of the American College of Cardiology, found that men who maintained higher levels of fitness tended to develop high blood pressure significantly later than less-fit men.

“We think improving fitness can slow the natural increased trend of systolic blood pressure with aging,” says Dr. Xuemei Sui, an assistant professor at the Arnold School of Public Health at the University of South Carolina and one of the study’s coauthors.

Sui and her colleagues’ data suggest the systolic blood pressure (the top number) of men with higher fitness levels reaches prehypertension – the level between normal and high blood pressure – at a much later age, on average: at 54, compared to an average of 46 in less fit men.

The research team analyzed medical exam records of nearly 14,000 men, ranging in age from 20 to 90, who were followed over a 36-year period. The research team divided the men into three equal groups of fitness: low (the bottom one-third), moderate, and high (the upper one-third).

Aside from the delay in the development of high blood pressure, the study also found that men in the higher fitness category had other more favorable health outcomes compared to those in the lower groups, including lower body mass index scores, percent of body fat, and cholesterol. These findings, Sui says, aren’t surprising. What was surprising, she says, was the significant delay in hypertension.

So, what should the men out there do?

“Physical activity is the primary determinant of fitness level,” Sui says.

Doc: ‘Distorted’ Report May Hurt Hypertension Patient Compliance

By Dr. Daniel E. Forman
Guest Contributor

A recent news article on blood pressure medications and the elderly is stirring up controversy among cardiologists and physicians who treat older patients.

The article, published in The New York Times earlier this month, analyzes a medical study in which researchers looked at the utility of a walking test to identify patients who may not benefit from anti-hypertensive therapy. But the Times piece misrepresents the study, in my opinion, and will likely exacerbate non-compliance for an already notorious problem: the undertreatment of high blood pressure.

Here’s the back story:

The medical study led by Michelle Odden and published online in the journal Archives of Internal Medicine on July 16, was primarily an epidemiologic assessment of a database — not a controlled clinical trial. The study falls far short of an evidence-based randomized trial about hypertension and doesn’t have the rigor of anything that justifies a major therapeutic impact. But The New York Times account on August 8 by Paula Span, described the study as a potential indictment against routine treatment of blood pressure in older adults. Furthermore, the premise of the study, as reported in the NYT, is distorted and the reporter’s characterization of the data exaggerated. (For instance, the study doesn’t clearly refute value of anti-hypertensive medications — it is primarily a trial about treatment stratification.) It does not match other blood pressure trials in rigor and substantive clinical method and it simplifies very complex issues regarding frailty/risk stratification/and even old age. On the basis of the NYT article many patients are likely to become more skeptical about the use of their blood pressure meds.

Odden focused on novel steps to stratify care for older adults with hypertension, i.e., assessing the utility of walking speed to identify subgroups of adults aged 65 years and older who are less likely to benefit from standard therapeutic strategies. The concern is that so-called “evidence-based standards” were derived using data from younger adults and/or particularly healthy trial-eligible older adults and that these treatment parameters may not benefit real-world frail older adults. Continue reading

Video: Use Smartphone Feedback To Get Healthier

As director of Partners HealthCare’s Center for Connected Health, Dr. Joseph C. Kvedar works on breaking down the barriers created by the idea that “you have to visit someone in a physical location to get health care services.”

More on that soon — and on how health reform will help spur that momentum. For now, Joe kindly answers a basic question: Right this moment, with current technology and the current health care system, how can we best use our smartphones to get healthier?

There are scads of health-related apps on the market, but Joe boils down his advice to under three minutes and begins with this: “Probably the simplest thing we can all do is track activity,” and smart pedometers these days can send our numbers of steps wirelessly to phones or Websites for easy graphing and reminders. Technophile readers, any recommendations?

Must-Read: Why Do Black Yale Men Die So Young? Is It ‘John Henryism’?


As we age, it’s normal to start losing a sprinkling of classmates to accidents and disease. But what’s happening to the pioneering black men of the Yale class of 1970 is not normal. At a deeply disturbing rate, they are dying off by around age 60. Among the 32 African-American men of the Yale class of ’70, the death rate appears to be roughly triple that of their white classmates.

Reporter and Brooklyn College journalism professor Ron Howell documents this frightening phenomenon in a superb article just out here in the Yale alumni magazine titled “Before their time.” He mixes his fond memories of the extraordinary friends he has lost with analysis from experts about possible explanations. He writes:

Demographers tell me not to extrapolate too far with these numbers, which are by no means a valid sampling. But for those of us who have been thinking about this for years, the numbers have profound meaning. Denis E. Kellman ’70, an attorney, lost his two best friends, Carl Palmer ’70 and Ron Norwood, in 2005 and this past February, respectively. “I feel like the last man standing,” Kellman says.

That black males overall die before others in America is well established. According to the latest National Vital Statistics report, life expectancy is 80.6 years for women in America overall and 75.7 for men. For white women, it’s 80.9; for black women, 77.4. For white men, 76.2. For black men, 70.9.

Much of that difference can be ascribed to poverty, violent crime, and inequitable access to health care, and might be expected to narrow for black men of higher socioeconomic status. So the question is this: are the black men who went to Yale and similar institutions in the throes of the blooming civil rights era of the ’60s—and who represented the first significant presence of African Americans on Ivy League campuses—now experiencing inequality in death, as their forebears did in life?

Many scientists, it pains me to report, believe the answer is yes.

Sociologist David R. Williams has done research showing that racial disparities in death rates pertain at “every level of income.” In a 2002 paper, Williams went on to say something as surprising as it is ominous: “This pattern has been observed across multiple health outcomes, and for some indicators of health … the racial gap becomes larger as [the socioeconomic status] increases.”

What in the world is going on here? Ron offers the “John Henryism” hypothesis:

One reason for this, researchers believe, is a phenomenon known as “John Henryism,” a determination among these men to succeed even at the cost of their health. Duke psychiatrist Christopher L. Edwards explained the idea in reporting on a 2006 study: Continue reading

Take This Study With Many Grains Of Salt: More Salt Linked To Fewer Cardiac Deaths

Stop. Step away from the chips and pickles.

True, a European study that just came out in the Journal of the American Medical Association would seem to suggest that eating a lot of salt actually reduces your risk of cardiac death. It would seem to fly in the face of years of warnings that too much salt is bad for us, and the mounting public health efforts in cities like New York and Boston to help people limit their salt.

But Dr. Randall Zusman, director of the section on hypertension and vascular medicine at the Massachusetts General Hospital Heart Center, says the study is absolutely not a “pass” to the pickle jar. Rather, he says, it opens the way to some interesting hypotheses that remain to be explored.

The study followed more than 3,600 subjects for several years, and found the highest number of cardiac deaths in those who consumed the least salt, as tested once in their urine. Those with the highest salt intake had the lowest number of deaths. Higher salt intake also didn’t seem to translate to higher blood pressure over time. The authors conclude that lowering salt intake is helpful for people who already have high blood pressure, but not as a policy for the population at large.

I asked Dr. Zusman to explain.

Q: I’m feeling totally confused. If i’m reading this JAMA study correctly, salt consumption was actually linked to a lower risk of death, which contradicts everything I thought I knew about avoiding salt to avoid hypertension. Please set me straight!

Dr. Randall Zusman of Massachusetts General Hospital

You read it correctly. That’s the conclusion that they would like to suggest as the result of their findings. The problem is that this was not intended to be an assessment of the benefits of the reduction of salt intake as an intervention for global population health.

They took a bunch of people and they looked at their salt intake, and they found, looking in a very narrow fashion, that the more salt you ate, the lower your risk. It’s completely contrary to everything that we believe. But they also found that rather dramatic changes in salt intake — 100 millimoles which is about two grams of salt — changed blood pressure by about two points, which we know from other studies ought to increase risk. Two points on a population basis is significant, though on an individual basis it’s not.

As the authors point out, not only are their results controversial, but they have a lot of faults or shortcomings. They didn’t take these people and then prospectively attempt to control their salt intake and look at the impact of modifying their salt ingestion. They took one urine sample at one point of time and took a hugely broad brush and made conclusions for the world.

Q: So what should we make of their findings? Continue reading

Fresh Bits Of Good News On MA Health Reform: ER Visits, Diabetes, Blood Pressure

These health-reform-anniversary factoids just in from the Massachusetts League of Community Health Centers and Health Care For All:

Preliminary data:
-Emergency department visits for approximately 60,000 Boston residents enrolled in Neighborhood Health Plan decreased overall by 20 percent between 2008 and 2010. More specifically, of those residents who are Commonwealth Care members the decline in ER visits fell 57 percent. This drop is striking as it demonstrates how effectively patient behavior can be impacted, particularly among those with previously limited access to the primary care system.

-Aggressive disease management programs targeting high-cost patients with chronic illnesses like diabetes improve health and keep care in lower-cost settings:
Patients enrolled in Lynn Community Health Center’s diabetes management program between 2008 and 2010 achieved a 21 percent drop in blood sugar levels. The program places intense focus on prevention screenings and self-management of the disease with the help of a team of nurse case managers and community health workers.

-Hypertensive patients receiving care at Neponset Health Center in Dorchester between 2008 and 2010, 14 percent saw an improvement in blood pressure readings. According to the US Centers for Disease Control and Prevention, as many as 29 percent of US adults have high blood pressure (an indicator of hypertension) and less than a third of them have it under control. As little as a 12 to 13 point reduction in blood pressure in the population could reduce heart attacks by 20 percent, strokes by 37 percent and deaths from all cardiovascular diseases by 25 percent. Overall, the combined cost to employers from diminished productivity as a result of three obesity-related health conditions (hypertension, heart disease and diabetes) is estimated at $1,018 per employee per year.