Background: Ischaemic heart disease (IHD) is the leading cause of mortality worldwide. Although modifiable cardiovascular risk factors, such as hypertension, diabetes and hyperlipidaemia, account for a large proportion of IHD the extent to which they are controlled is variable. The reasons for this undermanagement of risk factors is multifactorial and sociodemographic factors, such as marital status, could play an important role. This is especially important in light of recent evidence of higher mortality rates in single patients following acute coronary syndrome. However, more research is required into the impact of marital status on mortality in patients with cardiovascular risk factors.

Objectives: We aimed to investigate the impact of marital status on mortality of a large database of patients admitted with hypertension, hyperlipidaemia and type 2 diabetes.

Methods: Anonymous information on patients with hypertension, hyperlipidaemia and type 2 diabetes was obtained from hospitals in North England between 1^st  January 2000 and 31^stMarch 2013. This data was analysed according to the ACALM (Algorithm for Comorbidities, Associations, Length of stay and Mortality) study protocol. ICD-10 and OPCS-4 codes were used to trace patients and demographics including marital status, comorbidities and mortality data.  Mortality of patients of different marital statuses were compared by cox regression adjusted for age, gender, ethnicity and the top 10 contributors to mortality in the UK. P values <0.05 were taken as statistically significant.

Results: Amongst 929552 adult patients admitted during the study period there were 168431 patients with hypertension, 53055 with hyperlipidaemia and 68098 patients with type 2 diabetes. Crude mortality was highest among widowed patients in all 3 conditions. Logistic regression accounting for age, gender, ethnicity and the top contributors to mortality in the UK showed that married people, as compared to single people, with hypertension (OR 0.900), hyperlipidaemia (OR 0.836) and type 2 diabetes (OR 0.860) had significantly lower mortality rates. Adjusted mortality rates were also lower in widowed patients with hypertension (OR 0.973) and in both widowed and separated patients with type 2 diabetes (OR 0.965 and 0.974, respectively). Conversely, unmarried patients had significantly raised adjusted mortality rates in type diabetes (OR 1.046) and in hypertension (1.034).

Conclusion: Single patients with modifiable risk factors have significantly higher mortality rates compared to married patients which could help to explain the raised mortality rates documented in single patients following an acute coronary syndrome. Protective effects of marriage likely result from increased social support leading to healthier lifestyles and increased medication compliance. Our findings suggest a need for increased social support for single patients with modifiable cardiovascular risk factors.