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Roberto De Vogli, PhD, MPH; Tarani Chandola, DPhil; Michael Gideon Marmot, PhD, FRCP

Arch Intern Med. 2007;167(18):1951-1957.

Background  The aims of the study were to (1) analyze the association between negative aspects of close relationships and increased risk for coronary heart disease and (2) examine whether the association is stronger among women and people of lower social position.

Methods  Prospective cohort study of 9011 British civil servants (6114 men and 2897 women). Negative aspects of close relationships and other social support measures (confiding/emotional and practical) were assessed with the Close Persons Questionnaire during phase 2 (1989-1990) or phase 1 (1985-1988). Associations between negative aspects of close relationships and incident coronary events were determined during an average follow-up period of 12.2 years. Covariates included sociodemographic characteristics (age, sex, marital status, and employment grade), biological factors (obesity, hypertension, diabetes mellitus, and cholesterol level), psychosocial factors (negative affectivity, depression, and work stress), and health behaviors (smoking, alcohol intake, exercise, and fruit and vegetable consumption).

Results  After adjustment for sociodemographic characteristics, biological factors, and other dimensions of social support, individuals who experienced negative aspects of close relationships had a higher risk of incident coronary events (hazard ratio, 1.34; 95% confidence interval, 1.10-1.63). The association was attenuated but remained statistically significant after additional adjustment for negative affectivity and depression (hazard ratio, 1.25; 95% confidence interval, 1.02-1.55). Although women and men in a lower employment grade were more likely to be exposed to negative aspects of close relationships, sex and social position had no statistically significant interaction effects. Confiding/emotional and practical support were not associated with incident coronary events.

Conclusion  Adverse close relationships may increase the risk of heart disease.

Author Affiliations: International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, London, England.

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