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Heartache can actually be bad for your heart - if you're a woman, that is.

According to new research from the University of Utah, women in strained marriages are more likely to suffer the risk factors for heart disease than their husbands.

Those risk factors, known as metabolic syndrome, comprise five symptoms: hypertension, obesity at the waistline, high blood sugar, high triglycerides and low levels of HDL, the "good cholesterol."

Heart disease, diseases of the blood vessels and strokes account for the death of more Canadians than any other disease, according to the Heart and Stroke Foundation.

They are responsible for 31 per cent of all male deaths and 33 per cent of all female deaths.

While smoking, diet and exercise remain key factors leading to metabolic syndrome, emotional health does have a moderate effect, says Tim Smith, a psychology professor and co-author of the study.

The emotional stress of a bad marriage "seems to have about as much of an influence as does being a couch potato."

The findings are to be presented today in Chicago at the annual meeting of the American Psychosomatic Society, an interdisciplinary group of physicians interested in the connection between mental and physical health.

Dr. Smith and his colleagues, including lead author and doctoral student Nancy Henry, assessed 276 couples aged 40 to 70 who were married an average of 20 years. Each couple completed questionnaires covering the positive and negative aspects of their unions. The negative aspects included arguments, feelings of hostility and the extent of arguments over kids, money, sex and in-laws. As part of the study, couples visited a university clinic where they underwent medical testing including measurements for waist circumference, blood pressure, cholesterol, glucose and triglycerides.

Participants also answered questions aimed at identifying symptoms of depression, which many researchers believe contributes to metabolic syndrome, which, in turn, can lead to heart disease. "You can think about it as sort of a pathway," Dr. Smith says.

While men and women in bad marriages both reported depressive symptoms, only the women had more signs of metabolic syndrome. In other words, men appear to be insulated from the medical problems that this kind of emotional strain can cause.

Dr. Smith suspects this may have something to do with women's increased attentiveness to the quality of their personal relationships. "Men are a little slower on the uptake when things are drifting off optimal," he says. "They may not be as concerned when that happens. And they may work less hard to do something about it."

Acknowledging that not all men and all women behave this way, Dr. Smith says, on average, the stereotypes appear to be true. "I think of it as a chronic strain or burden. Those are difficulties that fall disproportionately to women in marriages. It takes its toll."

While the study only looked at married couples, Dr. Smith says the findings would likely be similar for couples in any long-term relationship.

The findings add to a growing body of knowledge about gender-specific risks for heart disease, says nurse practitioner Natasha Prodan-Bhalla, who runs a new heart-disease prevention program at BC Women's Hospital & Health Centre.

"It highlights the gestalt that is being a woman and how there are so many different things at play," says Ms. Prodan-Bhalla, who was not involved in the study.

"It's not just about having hypertension and high cholesterol, there's also an emotional component, a hormonal component, a depressive component. It's a package for us."

Her program screens for depression as an independent early risk factor for heart disease, alongside such better-known factors as obesity and prediabetes. "We don't know if depression is the chicken or the egg yet," she says. "But we know that in women who are depressed, we're more likely to see heart disease."

Medically speaking, Dr. Smith says one mechanism at work may lie in the body's response to chronic stress, such as the role of cortisol, a stress hormone, in facilitating the depositing of fat in the abdominal cavity.

"That's the linchpin of metabolic syndrome."

Dr. Smith says it would be premature to suggest that women in bad marriages would be healthier if they dumped their spouses.

Even so, "satisfying relationships are their own reward," he says. "But [heart health] is another benefit to be paying attention to them."