Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2021; 13(8): 340-347
Published online Aug 26, 2021. doi: 10.4330/wjc.v13.i8.340
Association of marital status with takotsubo syndrome (broken heart syndrome) among adults in the United States
Duke Appiah, Rachel Farias, Dena Helo, Linda Appiah, Olugbenga A Olokede, Chike C Nwabuo, Nandini Nair
Duke Appiah, Rachel Farias, Dena Helo, Olugbenga A Olokede, Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
Linda Appiah, College of Education, Texas Tech University, Lubbock, TX 79409, United States
Chike C Nwabuo, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, United States
Nandini Nair, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
Author contributions: Appiah D, Nwabuo C, and Appiah L, conceived and performed conceptualization, analysis, and interpretation of data; Appiah D, Farias R, and Helo D wrote the manuscript; Farias R, Helo D, Appiah L, Olokede O, Nwabuo C, and Nair N reviewed and edited the manuscript, and provided expertise and feedback.
Institutional review board statement: All procedures of the National Hospital Discharge Survey were approved by the institutional review board of the National Center for Health Statistics. Because the National Hospital Discharge Survey data is deidentified and publicly available, the Texas Tech University Health Sciences Center Institutional Review Board determined that this current study did not require a review.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: All data are from the National Hospital Discharge Survey and are publicly available through the Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/nhds/index.htm.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Duke Appiah, PhD, Assistant Professor, Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 9430, Lubbock, TX 79430, United States. duke.appiah@ttuhsc.edu
Received: February 24, 2021
Peer-review started: February 24, 2021
First decision: February 28, 2021
Revised: March 28, 2021
Accepted: July 27, 2021
Article in press: July 27, 2021
Published online: August 26, 2021
Abstract
BACKGROUND

The pathophysiology of takotsubo syndrome (TTS) is not well understood, however, it is often precipitated by psychological or physical stress. Marital status is related to emotional stress, but its associations with TTS are limited.

AIM

To explored the potential association between marital status and TTS.

METHODS

We conducted a case-control study using data on patients aged ≥ 40 years with marital status data in the National Hospital Discharge Survey (2006-2010). The International Classification of Diseases Ninth Revision codes were used to identify cases with TTS and other comorbid conditions. Each case was matched to 5 controls by age, sex, year of TTS diagnosis and bed size of hospital. Two sets of controls were selected: Acute myocardial infarction (AMI) controls and non-cardiovascular disease (CVD) controls. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association of marital status with TTS.

RESULTS

The 59 patients with TTS who had information on marital status were matched to 295 controls with AMI and 295 non-CVD controls, resulting in a sample of 649 patients. The average age of cases was 69.7 ± 11 years with 90% being women and 88% reporting White race. In multivariable-adjusted models, compared to singles, patients who were married had lower odds of TTS (OR = 0.86, 95%CI: 0.79–0.93) while those who were widowed (OR = 1.14, 95%CI: 1.05–1.23) or divorced/separated (OR = 1.32, 95%CI: 1.21–1.45) had elevated odds for TTS when compared to non-CVD controls. Similar results were observed when cases were compared to controls with AMI.

CONCLUSION

In this study, being married was associated with lower odds for TTS while being divorced/separated or widowed was related to elevated odds for TTS. These novel findings that underscore the potential importance of social factors like marital status in the development of TTS need confirmation in larger studies.

Keywords: Stress-induced cardiomyopathy, Takotsubo syndrome, Marital status, Epidemiology, Case-control, Marriage

Core Tip: Being married was associated with lower odds for takotsubo syndrome (TTS) while being divorced/separated or widowed was related to elevated odds for TTS.