Marital status and quality in middle-aged women: Associations with levels and trajectories of cardiovascular risk factors

The current study compared cardiovascular risk profiles and trajectories (i.e., within-person changes) of women who were married or cohabitating and who had high relationship satisfaction with those of women with moderate or low satisfaction and with those of women who were single, divorced, and widowed. Participants were 493 women from the Healthy Women Study, a prospective investigation of health during and after the menopausal transition. Risk factors were measured across more than 5 occasions and 13 years, on average. Data were analyzed using a multilevel modeling technique. Overall, women in relationships with high satisfaction had lower levels of biological, lifestyle, and psychosocial risk factors when compared with the other groups. In some cases, women in satisfying marriages also showed a lower risk trajectory on risk factors relative to other women. Hence, marriage appears to confer health benefits for women, but only when marital satisfaction is high. Key words: cardiovascular diseases, marriage, psychosocial, interpersonal stress, risk factors Higher levels of social integration and support have been linked with a number of health benefits (e.g., House, Landis, & Umber-son, 1988; Seeman, 1996), including protection against cardiovas-cular morbidity and mortality (e.g., Berkman, 1995; Hazuda, 1994; Orth-Gomér, 1994). The marital relationship is a primary source of support for many adults. Thus, some research has examined whether being married confers health-protective effects (e.g., Johnson, Backlund, Sorlie, & Loveless, 2000). Married men and women may be at a health advantage relative to their unmarried counterparts, for a number of reasons. First, as a primary source of social support, marriage may protect against the well-documented risks associated with social isolation (e.g., Berkman, 1995; Berkman & Glass, 2000; Brummett et al., 2001). Second, positive spousal influence and involvement may encour-age health-promoting behaviors and deter health-compromisin