Spousal metabolic risk factors and future cardiovascular events: A prospective cohort study

  • Azra Ramezankhani
    Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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  • Kamran Guity
    Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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  • Fereidoun Azizi
    Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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  • Farzad Hadaegh
    Corresponding author. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Floor 3rd, Number 24, Yemen Street, Shahid Chamran Highway, 19395-4763, Tehran, Iran.
    Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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      • We found a sex-specific effect of spousal metabolic risk factors on the risk of cardiovascular disease (CVD).
      • Men whose spouses were overweight had 41% higher risk of CVD.
      • Men whose spouses were obese had 38% higher risk of CVD.
      • In women, no associations were found between spousal risk factors and risk of CVD.
      • Our results may help early detection of individuals at high risk of CVD.


      Background and aims

      We investigated whether the presence of metabolic risk factors in one spouse is associated with increased risk of cardiovascular disease (CVD) in the other spouse.


      A total of 4390 married participants (2152 men and 2238 women free of CVD at baseline) aged ≥20 years were included in this study. The association between spousal risk factors and incident CVD was estimated separately for men and women (as index individuals) using Cox regression models, with spousal risk factors as exposures and CVD event in the index individuals as the outcome. Exposures included spousal body mass index (BMI), waist circumference, systolic and diastolic blood pressure, total cholesterol, high density lipoprotein cholesterol, fasting plasma glucose (all in both continuous and categorical forms) and smoking. Models were adjusted for the three nested sets of covariates.


      During a median follow-up of 16.1 years, 588 (419 men) cases of CVD were recorded. Among men, those whose wives were overweight and obese had significantly increased risk of CVD, compared with men whose spouses had normal weight, after adjusting for men risk factors. Hazard ratios (HR) with 95% confidence intervals (95% CI) were 1.41 (1.07–1.87) and 1.38 (1.03–1.85), respectively. Among women, no significant associations were observed between spousal metabolic risk factors and incidence of CVD, after controlling for their own risk factors.


      Findings from this study show that overweight and obesity in women increase their spouses' risk for CVD beyond the effect of the spouses’ own risk factors.

      Graphical abstract


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