Marital Status as a Factor in Cardiovascular Disease Risk Stratification: A Systematic Review and Meta-Analysis.

Background: Classic risk factors—such as age, sex, smoking, hypertension, hyperlipidemia, and diabetes—account for approximately 80% of the risk for cardiovascular disease (CVD). The remaining 20% of cardiovascular risk is attributed to factors that are still poorly characterized. One such factor with an unclear role is marital status. Method: The main databases—including PubMed, Scopus, and Web of Science—were systematically searched using appropriate keywords up to November 6, 2024. Co-authors independently and blindly extracted the data. A risk of bias assessment was conducted for the included studies. The outcomes were analyzed using STATA software version 13.1 and reported as pooled hazard ratios (HRs) with 95% confidence intervals. Result: In this meta-analysis, the incidence of CVDs across different marital statuses was analyzed using data from 13 cohort studies conducted in 11 countries, including 1,809,825 participants. Our results showed no significant differences in CVD incidence among married (HR 1.00, 95% CI 0.84-1.20) and unmarried individuals (HR 1.24, 95% CI 0.95-1.62); however, divorced individuals had a 28 % higher incidence (HR 1.28, 95% CI 1.14-1.44), and widowed individuals showed a 28 % higher incidence of CVDs (HR 1.28, 95% CI 1.11-1.48). High heterogeneity was noted across studies, with I-squared values ranging from 67.8% to 89.4%. Conclusion: The results show no difference in the incidence of CVD among married or single populations. However, divorced and widowed populations have an increased risk of CVD incidence. The high heterogeneity of the research highlights the complexity of the link. Our findings emphasize how crucial it is to take marital status into account when evaluating CVD risk and developing preventative measures.