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Affiliation and Control During Marital Disagreement, History of Divorce, and Asymptomatic Coronary Artery Calcification in Older Couples

Smith, Timothy W. PhD; Uchino, Bert N. PhD; Florsheim, Paul PhD; Berg, Cynthia A. PhD; Butner, Jonathan PhD; Hawkins, Melissa PhD; Henry, Nancy J.M. PhD; Beveridge, Ryan M. PhD; Pearce, Gale PhD; Hopkins, Paul N. MD, MSPH; Yoon, Hyo-Chun MD, PhD

doi: 10.1097/PSY.0b013e31821188ca
Original Articles

Objective: To examine behavioral observations of affiliation (ie, warmth versus hostility) and control (ie, dominance versus submissiveness) and prior divorce as predictors of coronary artery calcification (CAC) in older couples. In some but not all studies, marital disruption and low marital quality have been shown to confer risk of coronary artery disease (CAD). Inconsistencies might reflect limitations of self-reports of marital quality compared with behavioral observations. Also, aspects of marital quality related to CAD might differ for men and women.

Methods: Couples underwent computed tomography scans for CAC and marital assessments, including observations of laboratory-based disagreement. Participants were 154 couples (mean age, 63.5 years; mean length of marriage, 36.4 years) free of prior diagnosis of CAD.

Results: Controlling traditional risk factors, we found behavioral measures of affiliation (low warmth) accounted for 6.2% of variance in CAC for women, p < .01, but not for men. Controlling behavior (dominance) accounted for 6.0% of variance in CAC for men, p < .02, but not for women. Behavioral measures were related to self-reports of marital quality, but the latter were unrelated to CAC. History of divorce predicted CAC for men and women.

Conclusions: History of divorce and behavioral-but not self-report-measures of marital quality were related to CAD, such that low warmth and high dominance conferred risk for women and men, respectively. Prior research might underestimate the role of marital quality in CAD by relying on global self-reports of this risk factor.

CAD = coronary artery disease; CAC = coronary artery calcification; CHD = coronary heart disease; IPC = interpersonal circumplex; MAP = mean arterial blood pressure; SASB = structural analysis of social behavior.

From the Department of Psychology (T.W.S., B.N.U., P.F., C.A.B., J.B., M.H., N.J.M.H., R.M.B., and G.P.), University of Utah, Salt Lake City, Utah; Cardiovascular Genetics Division, Department of Internal Medicine (P.N.H.), University of Utah School of Medicine, Salt Lake City, Utah; and the Department of Diagnostic Imagery (H.-C.Y.), Kaiser Foundation Hospital, Honolulu, Hawaii.

Address correspondence and reprint requests to Timothy W. Smith, PhD, Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT 84112. E-mail:

Received for publication July 3, 2008; revision received November 10, 2010.

This work was supported, in part, by Grant RO1 AG 18903 (Principal Investigator: Timothy W. Smith) from the National Institutes of Health (T.W.S.) (Co-Principal Investigator: C.A. Berg; Co-Investigators: B.N. Uchino, P. Florsheim,P.N. Hopkins, and H.-C. Yoon).

Authors' Contributions: Drs. Smith, Uchino, and Berg had full access to all data in this study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Smith, Uchino, and Berg designed, directed, and analyzed results of the study. Dr. Florsheim designed and directed behavioral coding of the marital interactions. Dr. Butner advised and conducted structural equation modeling analyses. Drs. Hawkins, Henry, Beveridge, and Pearce coordinated data collection, coding, management, and analysis. Dr. Hopkins designed and directed collection and analysis of cardiovascular risk factors. Dr. Yoon directed collection and analysis of computed tomography scans of coronary artery calcification.

The authors have not disclosed any potential conflicts of interest.

Copyright © 2011 by American Psychosomatic Society
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