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Widowhood and severity of coronary artery disease: a multicenter study
Amin Daoulah1, Mohamed N Alama, Osama E Elkhateeb
1aCardiovascular Department bInternal Medicine Department, Section of Pulmonology cInternal Medicine Department, King Faisal Specialist Hospital and Research Center dCardiology Unit, King Abdul Aziz University Hospital, Jeddah eCardiac Center, King Abdullah Medical City, Makkah fCardiovascular Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia gCardiology Department, Zayed Military Hospital hDivision of Adult Cardiology, College of Medicine, Institute of Cardiac Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences iDivision of Adult Cardiology, College of Medicine, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE jAnesthesia Department kEmergency Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia lDepartment of Cardiology, Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA.
Insights
Widowhood is linked to more severe coronary artery disease (CAD), increasing the likelihood of needing bypass surgery. This association holds true regardless of sex or socioeconomic status.
Area of Science:
- Cardiology
- Public Health
- Sociology
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality globally.
- Socioeconomic factors and life events, such as widowhood, may influence health outcomes.
- The impact of widowhood on CAD severity and extent requires further investigation.
Purpose of the Study:
- To evaluate the association between widowhood and the severity and extent of coronary artery disease (CAD).
- To determine if sex or socioeconomic status modifies the relationship between widowhood and CAD.
- To assess the clinical implications of widowhood on CAD management.
Main Methods:
- A cohort of 1068 patients undergoing coronary angiography in Saudi Arabia and the UAE was analyzed.
- Coronary artery disease (CAD) was defined by lumen stenosis thresholds in major epicardial vessels or the left main coronary artery.
- Multivessel disease was defined as stenosis in more than one major coronary artery.
Main Results:
- Widowed patients (6% of cohort) were older, more likely female, less likely smokers, and had lower socioeconomic status.
- Widowhood was significantly associated with a higher number of diseased coronary arteries and increased likelihood of requiring coronary artery bypass graft surgery.
- Adjusted analyses revealed widowhood was associated with higher odds of CAD and multivessel disease, but not left main disease.
Conclusions:
- Widowhood is independently associated with increased severity and extent of coronary artery disease (CAD).
- The observed association between widowhood and CAD is not modified by sex or socioeconomic status.
- These findings highlight the importance of considering psychosocial factors in cardiovascular risk assessment and management.
Objectives:
The aim of this study was to assess the association of widowhood with the severity and extent of coronary artery disease (CAD), and whether it is modified by sex or socioeconomic status.
Patients And Methods:
A total of 1068 patients undergoing coronary angiography at five centers in Saudi Arabia and the United Arab Emirates were included in the study. CAD was defined as more than 70% lumen stenosis in a major epicardial vessel or more than 50% in the left main coronary artery. Multivessel disease was defined as more than one diseased vessel.
Results:
Of 1068 patients, 65 (6%) were widowed. Widowed patients were older (65±15 vs. 59±12), more likely to be female (75 vs. 25%), less likely to be smokers (18 vs. 47%), of lower economic and education status, and more likely to have undergone coronary angiography for urgent/emergent indications (75 vs. 61%) (P<0.05 for all). There was a significant association between widowhood and the number of coronary arteries with more than 70% lumen stenosis. Consequently, such a high degree of lumen stenosis in those who were widowed was more likely to require coronary artery bypass graft surgery (38 vs. 16%; P<0.01). After adjusting for baseline differences, widowhood was associated with a significantly higher odds of CAD [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI) 1.2-10.5] and multivessel disease (adjusted OR 4.6; 95% CI 2.2-9.6), but not left main disease (adjusted OR 1.3; 95% CI 0.5-3.1). All associations were consistent in men and women and not modified by age, community setting (urban vs. rural), employment, income, or educational levels (Pinteraction>0.1 for all).
Conclusion:
Widowhood is associated with the severity and extent of CAD. The association is not modified by sex or socioeconomic status.
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