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In sickness and in health: relationship quality and cardiovascular risk and management

Tulloch, Heather E.a; Greenman, Paul S.b,c,d

doi: 10.1097/HCO.0000000000000553
PREVENTION: Edited by Andrew Pipe

Purpose of review To review the link between couple relationships and cardiovascular health, the plausible mechanisms by which relationship quality affects heart health, and to provide an overview of couple-based interventions aimed at improving cardiovascular health.

Recent findings Marriage and the quality of the couple relationship bond are robust predictors of long-term health outcomes. Chronic relationship conflict and disconnection can be deadly. There are direct and indirect pathways by which couple relationship quality affect cardiovascular health. Direct pathways include effects of relationship quality on cardiovascular, neuroendocrine, and immune functioning. Indirect pathways include effects of emotional, cognitive and behavioural factors that impact lifestyle choices and adherence to treatment regimens. Effects of couple-based interventions addressing traditional cardiovascular risk factors have been null to modest and there is only one couple-based intervention that addressed relationship quality and heart health. On the basis of the literature, this is major oversight. We propose attachment-based interventions, such as our Healing Hearts Together program, for patients with heart disease and their partners.

Summary Previous research indicates that couple-based interventions are promising. Large randomized controlled trials that aim to improve relationship quality among patients with CVD and their partners, as well as study mechanistic, surrogate, and clinical outcomes, are required to appropriately assess their impact.

aDivision of Prevention and Rehabilitation, University of Ottawa Heart Institute

bUniversité du Québec en Outaouais, Gatineau, Québec

cInstitut du Savoir Montfort

dOttawa Couples and Family Institute, Ottawa, Ontario, Canada

Correspondence to Heather E. Tulloch, University of Ottawa Heart Institute, Division of Cardiac Prevention and Rehabilitation Centre, 40 Ruskin Street, Ottawa, ON K1Y4W7, Canada. Tel: +1 613 696 7000 x19705; e-mail:

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