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The linkage to each respective partner (defined as a married couple or a cohabiting couple with common children) was possible through annual extracts from the Register of the Total Population.If information on dog death was missing, we assumed a maximum lifespan of ten years.and incident disease data from the National Patient Register from January 1, 2001 to December 31, 2012 in the national cohort, and up to December 31, 2014 in the twin cohort.In addition to all-cause mortality, the main diagnosis in inpatient and outpatient care and underlying cause of death were used to define four incident disease outcomes: (1) acute myocardial infarction (ICD-10 I21); (2) heart failure (ICD-10 I50); (3) ischemic stroke (ICD-10 I63) and (4) hemorrhagic stroke (ICD-10 I60-I62).In individuals without CVD, dog ownership has been reported as inversely associated with the prevalence of cardiovascular risk factors, such as dyslipidemia, hypertension and diabetes.Although the American Heart Association issued a Scientific Statement in 2013 concluding that “[…] dog ownership is probably associated with decreased CVD risk […]” and that this effect “[…] may be causal […]”, earlier studies have had several limitations, including lack of power, low responder rates and incomplete adjustment for potential confounders.In the twin register only the composite CVD outcome and all-cause mortality were assessed.

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CVD mortality was defined as death with the underlying cause being any of the CVD outcomes defined above.The age range was chosen to exclude younger individuals at low risk of CVD and the elderly at low odds of owning a dog.Participants were identified using the Register of the Total Population, which contains information on birth, migration, changes of citizenship, civil status and death on all Swedish citizens and residents To verify findings from the national cohort in a subgroup with more available information on additional potential confounders, we repeated our analysis in the “Screening Across the Lifespan Twin study” (SALT) sub-study of the Swedish Twin Register (STR).Individuals with inpatient visits (n = 387,571 in national cohort and n = 3,163 in twin cohort) between January 1, 1987 to December 31, 2000 for CVD (ICD-9 codes 390–459 or ICD-10 I00-I99; main or secondary diagnosis) and/or had a coronary artery bypass grafting or percutaneous coronary artery intervention (Nordic surgical procedure codes FNA, FNC and FNG) were excluded from the study The final data set included 3,432,153 participants in the national cohort and 34,202 in the twin cohort (Supplementary Figure 1).Since January 1, 2001, it has been a statutory requirement that every dog in Sweden has a unique identifier (ear tattoo or subcutaneous chip) registered at the Swedish Board of Agriculture.

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