Traditionally, heart disease prevention has focused on individual risk factors, and treatment has focused solely on the patient. However, in recent decades, several psychosocial factors, such as poor mental health and social isolation, as well as positive social support, have been recognized as important predictors.

According to a study conducted in the US in 2024, while all sources of positive social relationships can protect against cardiovascular disease, partner support appears to be particularly important for predicting heart health.

“The couple-based approach, which involves actively integrating the partner into the therapeutic process, is not yet common practice, but we are increasingly trying to raise awareness of its importance,” said Diego Segura‑Rodríguez, MD, cardiologist at Hospital Universitario Clínico San Cecilio in Granada, Spain, and member of the Clinical Cardiology Association of the Spanish Society of Cardiology. He said the scientific evidence shows that the quality of intimate relationships influences cardiovascular health. We’re not just talking about being in a relationship, but about the nature of that relationship in terms of support, affection, conflict resolution, and loneliness within the couple, he said.

Relationship Effects on Physiology

He added, we know that a poor‑quality relationship is associated with more inflammation, worse blood pressure control, higher levels of hormonal stress, and poorer lifestyle habits. Conversely, a healthy relationship is associated with better treatment adherence, more exercise, a better diet, and a lower risk for cardiovascular events. The evidence in this area is solid and comparable in magnitude to classic factors such as smoking or a sedentary lifestyle.

Review of Couple-Based Trials

A review evaluating the effectiveness of partner‑based interventions on modifiable cardiovascular risk factors, cardiac outcomes, mental health, and relationship quality in adults with diagnosed heart disease and their partners suggests that couple relationships could be a key piece in the puzzle of heart disease and recovery. This work brings to the table something that many cardiologists have already been considering in practice for years: the importance of the social component for each patient. When heart disease enters a couple’s life, it can change roles, generate fear, affect dependence, and sometimes spark conflict. Treating only the patient is an incomplete view, Segura‑Rodríguez said.

Limitations and Interpretation

In the 2024 study, of all randomized controlled trials that included cardiac patients and their partners, 12 met the inclusion criteria. However, as Segura‑Rodríguez pointed out, the included clinical trials together include 1444 patients and their partners, which is not an insignificant number for clinical research. It should be noted that the studies are highly heterogeneous in duration, type of intervention, conditions included and outcomes measured. Furthermore, many are older and have modest sample sizes.

Segura‑Rodríguez acknowledged that the conclusions cannot be considered 100% conclusive, especially regarding major outcomes such as heart attacks, readmissions, or mortality. What they do allow, however, is a solid claim that these interventions improve health behaviors such as exercise, medication adherence, smoking cessation and have clinical potential.

Although, as the authors themselves acknowledge, the review showed that some cardiovascular outcomes, such as lipid profiles and healthcare utilization, improved, the findings were inconsistent. Furthermore, none of the three studies that evaluated the reference questionnaire found significant improvements. Nevertheless, the researchers insist on highlighting the potential of couple‑based interventions to improve healthy habits and coping with heart disease among patients and their partners.

Clinical Implications and Next Steps

“I think it’s a reasonable approach, although it should be used with caution and considered on a couple-by-couple basis. The fact that the studies did not find significant improvements in relationship quality does not mean the approach is not useful, but rather that the interventions evaluated were not truly aimed at improving the relationship,” Segura‑Rodríguez said. He added, “The studies nonetheless show consistently that working with the partner improves health habits, which are at the heart of secondary prevention: moving more, taking medication correctly, eating better, and quitting smoking. That alone is a very important clinical benefit.”

As the study concludes, while a stepped-care model of in cardiac rehabilitation can help tailor interventions to the specific needs of couples, future research should include emotional and relational components, underserved populations, validated relationship measures, and assessments of outcomes in both patients and partners. 

“At our hospital, partners are allowed to attend educational sessions or talks, but a formal structure that addresses relationship dynamics, communication, and joint coping with the disease has yet to be defined. In Spain, this tends to depend on the sensitivity of the team, although this inertia is gradually changing,” Segura‑Rodríguez said. He explained that including the partner does not mean turning cardiology into couples therapy, but recognizing the relationship as a fundamental “therapeutic context.” In the early stages, shared education and structured support may suffice, and in more complex cases, specific interventions should be considered.

From his perspective, the future, or rather, the present, of cardiac rehabilitation lies in being more humane and holistic, considering the patient and their environment. It’s not just about restoring hearts but also about nurturing relationships. After all, recovery also means learning to live together again with a chronic disease.

The authors declared having no relevant conflicts of interest.

This story was translated from Univadis Spain, part of the Medscape Professional Network.