March 3, 2006 -- Hardening of the coronary arteries is more likely
in wives when they and their husbands express hostility during
marital disagreements, and more common in husbands when either
they or their wives act in a controlling manner.
Those are key findings of a study of 150 healthy, older, married
couples – mostly in their 60s – conducted by Professor
Tim Smith and other psychologists from the University of Utah.
Smith was scheduled to present the findings Friday March 3 in
Denver during the annual meeting of the American Psychosomatic
Society, which deals with the influence of psychological factors
on physical health.
“Women who are hostile are more likely to have atherosclerosis
[hardening of the coronary arteries], especially if their husbands
are hostile too,” Smith says. “The levels of dominance
or control in women or their husbands are not related to women’s
“In men, the hostility – their own or their wives
hostility during the interaction – wasn’t related
to atherosclerosis,” he adds. “But their dominance
or controlling behavior – or their wives dominance –
was related to atherosclerosis in husbands.”
Smith summarizes: “A low-quality relationship is a risk
factor for cardiovascular disease.”
Smith conducted the study with University of Utah psychologists
Cynthia Berg, a professor; Bert Uchino and Paul Florsheim, both
associate professors; and Gale Pearce, a Utah postdoctoral fellow
now on the faculty of Westminster College in Salt Lake City.
Marital Disputes in the Laboratory
The study – which began in 2002 and ended in 2005 –
involved 150 married couples with at least one member between
60 and 70 years of age and the other one no more than five years
older or younger. The couples were recruited through newspaper
advertisements and a polling firm. Those who participated had
no history of cardiovascular disease and were not taking medicine
Each husband and wife was paid $150 to participate, and also
received free of charge a $300 CT scan to look for calcification
in their coronary arteries – the arteries that supply the
heart muscle and that can cause a heart attack when clogged. Smith
says that in otherwise healthy people, calcification represents
hardening and narrowing of the arteries that puts them at risk
for later heart attack.
Each couple was told to pick a topic – such as money, in-laws,
children, vacations and household duties – that was the
subject of disagreements in their marriage. Then, while sitting
in comfortable chairs and facing each other across a table, each
couple discussed the chosen topic for six minutes while they were
Psychology graduate students coded the videotaped conversations
so that “each comment that reflected a complete thought”
was given a code indicating the extent to which it was friendly
versus hostile, and submissive versus dominant or controlling.
For example, comments like, “You can be so stupid sometimes”
or “you’re too negative all the time,” were
coded as hostile and dominant. Another dominant or controlling
comment would be, “I don’t want you to do that; I
want you to do this.”
“A warm, submissive comment would be, ‘Oh that’s
a good idea, let’s do it,’” Smith says. “A
less warm one would be, ‘If it’s important to you,
I’ll do what you want.’ An unfriendly, submissive
comment is, ‘I’ll do what you want if you get off
Smith says some of the marital discussions were calm and peaceful,
but in some cases, the couples were quite hostile, prompting the
psychology graduate students to refer them to marriage counseling.
The researchers assumed that a couple’s behavior during
the discussion reflected their long-term pattern of behavior,
although a marital spat in front of researchers likely “is
a muted version of what goes on at home,” Smith adds.
Two days after their discussion, each couple underwent a CT scan
of the chest at the University of Utah’s Center for Advanced
Medical Technologies. Doctors used a standard scale to score each
person’s level of coronary artery calcification –
an indicator of atherosclerotic plaque buildup in the arteries
that supply blood to the heart.
Since the participants were healthy, none of the “silent”
atherosclerosis revealed by the CT scans amounted to a medical
emergency. “But there were people who had scores high enough
they needed to discuss it with their doctor, because statistically
it placed them at a high risk of a coronary event,” Smith
Findings of the Study
The researchers found:
- The more hostile the wives’ comments during the discussion,
the greater the extent of calcification or hardening of the
arteries. And “particularly high levels of calcification
were found in “women who behaved in a hostile and unfriendly
way and who were interacting with husbands who were also hostile
- The extent to which either wives or husbands acted in a dominant
or controlling manner was unrelated to the severity of hardening
of the arteries in the wives.
- The extent to which wives or husbands spoke with hostility
had no relationship to the severity of hardening of the arteries
in the husbands.
- Husbands who displayed more dominance or controlling behavior
– or whose wives displayed such behavior – were
more likely than other men to have more severe hardening of
“Another way to say it is that either being controlling
or being married to someone who is controlling is enough to promote
atherosclerosis in men,” says Smith “So in couples
where there was not a struggle for control – where it wasn’t
a contest – those men had much lower levels of atherosclerosis.
To sum it all up, hostility during marital disputes was bad for
women’s hearts, while controlling behavior during marital
disputes was bad for men’s hearts.
“Disagreements are an unavoidable fact of relationships,”
says Smith. “But the way we talk during disagreements gives
us an opportunity to do something healthy.”
“If you were concerned about men’s heart health,
you would ask couples to find ways to talk about disagreements
without trying to control each other. If you were concerned about
women’s heart health, you would encourage couples to find
ways to have disagreements that weren’t hostile.”
And for spouses concerned about each other, avoid both hostility
and controlling behavior during disagreements, he adds.
Putting the Findings in Context
Previous research indicates “close relationships are good
for our heart health. Having relationships places you at lower
risk than feeling lonely and isolated,” Smith says. But
the new study suggests “that the quality of those relationships
In addition, “the dimensions of quality that are important
differ for men and women. Conventional views of harmony versus
discord – how warm versus hostile interactions are –
are indeed important for women. But a different dimension of quality
is more important for men, and that has to do with power and control
Smith says a common factor is anger: wives’ anger from
feeling hostility or being subject to hostility; and husband’s
anger from experiencing or at least perceiving a challenge to
their sense of control.
That “certainly is consistent with a large body of prior
literature on emotions, relationships and health,” he adds.
“What’s novel about this study is taking a snapshot
of how couples talk to each other and relating that to a silent,
progressive and potentially deadly disease.”
Smith also offers another caution about the findings.
“People get heart disease for lots of reasons,” he
says. “If someone said, ‘What’s the most important
thing I can do to protect my heart health?’ my first answers
would be, ‘Don’t smoke,’ ‘Get exercise’
and ‘Eat a sensible diet.’ But somewhere on the list
would be, ‘Pay attention to your relationships.’