If you think your marriage is killing you, you just may be right. While it's well-established that stress is a clear-cut cardiac risk factor for men, new data is finally demonstrating a similar and important association for women.

A research team headed by Kristina Orth-Gomer, MD, PhD of the Karolinska Institute in Sweden recently reported "marital stress but not work stress predicts poor prognosis in women aged 30-65 years with coronary heart disease."

In their article published in the Journal of the American Medical Association (JAMA) on December 20, 2000, Orth-Gomer and colleagues documented marital stress levels in 292 women hospitalized for heart attacks or unstable angina between 1991 and 1994. Participants were studied for a period of almost 5 years after the original hospitalization.

Realizing many issues could cloud their results, the researchers specifically factored in age, sedentary lifestyle, estrogen status, education, smoking, lipid levels and a host of other potential variables that could have altered the outcome of their study. Yet after careful analysis, the data was clear.

Among women who were married or cohabitating, marital stress was associated with almost a three-fold increase in recurrent cardiac events and death. While work stress was not established as a significant risk factor, the authors do not infer this may not be detrimental under certain circumstances as well.

Your boss is not off the hook yet!

And while the cardiac prognosis for married men seems to be better than for single men, such was not the case for these women. According to the researchers, "in fact, being married or cohabitating in itself did not provide any extra protection, but strain from a problematic spousal relationship significantly contributed to a poor prognosis over and above the effect of clinical predictors."

What does this tell us?

The bottom line is simple. Marital discord increases the risk of cardiac death in women.

Yet there's more to consider. Women view relationships with their spouses far less supportive than one might assume. Actually men are much more likely than women to consider their spouse as the primary provider of social support. Coupled with significant biological differences and other risk factors, the unique needs of women must be addressed in the evidence-based spectrum of cardiac risk factor management.

Where does this leave us?

Let’s not rush to the divorce court yet!

Instead, let's seriously consider marital stress as a major cardiac risk factor for women. Simple categorization by the medical establishment isn't enough. With these new findings, we must now address the issue of marital relationships with the same level of seriousness as estrogen replacement, diet, exercise, blood pressure, lipid levels and smoking.

This is a wake-up call. Mind-body connection risk factors are simply not going to evaporate into thin air. These issues require serious attention in the conventional medical arena. When will we as a society realize that antidepressant medications are not a panacea? When will insurers appropriately cover psychosocial interventions?

It's time physicians, learning about marital conflict from their patients, take a proactive stance and prescribe counseling as a potential life-saving intervention. Ignoring what may very well be a critical risk factor for a given patient may be tantamount to sealing one’s fate. The medical profession must not avoid addressing these issues for fear of letting Pandora out of the box. The latest drug is not going to cure a broken marriage ... or a broken heart.

And for women reading this column who are downtrodden by a relationship metaphorically perceived as a time-bomb, it’s time to take a closer look at your life. Realize the importance of your psychological, spiritual and physical well-being, and prioritize your time to work things out with your partner ... or begin again.

Yes, your marriage may be killing you - but only if you allow it to do so. Weigh the pros and cons of your relationship and realize if you both care enough, your differences can be resolved. Perhaps it's time to work it out ... heart to heart - Mind Over Matter!