http://heart.bmj.com/content/early/2018/03/16/heartjnl-2017-312663
Coronary artery disease
Original research article
Social isolation and loneliness
as risk factors for myocardial infarction, stroke and mortality: UK
Biobank cohort study of 479 054 men and women
Abstract
Objective
To examine whether social isolation and loneliness (1) predict acute
myocardial infarction (AMI) and stroke among those with no history of
AMI or stroke, (2) are related to mortality risk among those with a
history of AMI or stroke, and (3) the extent to which these associations
are explained by known risk factors or pre-existing chronic conditions.
Methods
Participants were 479 054 individuals from the UK Biobank. The
exposures were self-reported social isolation and loneliness. AMI,
stroke and mortality were the outcomes.
Results
Over 7.1 years, 5731 had first AMI, and 3471 had first stroke. In model
adjusted for demographics, social isolation was associated with higher
risk of AMI (HR 1.43, 95% CI 1.3 to –1.55) and stroke (HR 1.39, 95% CI
1.25 to 1.54). When adjusted for all the other risk factors, the HR for
AMI was attenuated by 84% to 1.07 (95% CI 0.99 to 1.16) and the HR for
stroke was attenuated by 83% to 1.06 (95% CI 0.96 to 1.19). Loneliness
was associated with higher risk of AMI before (HR 1.49, 95% CI 1.36 to
1.64) but attenuated considerably with adjustments (HR 1.06, 95% CI 0.96
to 1.17). This was also the case for stroke (HR 1.36, 95% CI 1.20 to
1.55 before and HR 1.04, 95% CI 0.91 to 1.19 after adjustments). Social
isolation, but not loneliness, was associated with increased mortality
in participants with a history of AMI (HR 1.25, 95% CI 1.03 to 1.51) or
stroke (HR 1.32, 95% CI 1.08 to 1.61) in the fully adjusted model.
Conclusions
Isolated and lonely persons are at increased risk of AMI and stroke,
and, among those with a history of AMI or stroke, increased risk of
death. Most of this risk was explained by conventional risk factors.
Introduction
Individuals
who are socially isolated (ie, are lacking social contacts and
participation in social activities) or feel lonely (ie, feel that they
have too few social contacts or are not satisfied with the quality of
their social contacts) have been found to be at increased risk of
incident coronary heart disease (CHD),1 stroke2 and early mortality.3–7
A recent meta-analysis—including 11 longitudinal studies on
cardiovascular disease and 8 on stroke—suggested that social isolation
and loneliness are associated with 30% excess risk of incident CHD and
stroke.8 However, most of the studies were small in scale, with only one study reporting more than 1000 events,1 and meta-analytic evidence suggests selective publishing of positive findings.8
Furthermore, only a limited set of potential explanatory factors have
been examined in previous studies and mortality after incident CHD or
stroke remains unexplored. Thus, it remains unclear whether these
associations are independent of biological, behavioural, psychological,
health and socioeconomic factors9–11 that are known to increase risk of cardiovascular diseases.12 13 In addition, although other risk factors, such as physical inactivity14 and depression,15
have been associated with poorer outcomes among individuals with
pre-existing cardiovascular disease, it remains unclear whether socially
isolated or lonely individuals have an elevated risk of early mortality
after cardiovascular disease event.
In this analysis
using the UK Biobank study, a very large prospective population-based
cohort study, we examined the associations of social isolation and
loneliness with first acute myocardial infarction (AMI) and first
stroke. In addition, we examined whether social isolation and loneliness
before AMI or stroke event are associated with mortality risk after the
event. A broad range of biological, behavioural, psychological,
socioeconomic and mental health-related factors were included as
potential mediators or confounders of these associations.
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