Social Isolation Linked to Increases in Cardiovascular Events, Death

Janine Gronewold, PhD

A new study has found social isolation may be more detrimental to the overall health of an older adult than previously thought.

Presented as part of the European Academy of Neurology (EAN) 2020 Virtual Congress, results of the study suggest those who are socially isolated were more than 40% more likely to have a cardiovascular event and at an even greater risk for all-cause mortality.

"We have known for some time that feeling lonely or lacking contact with close friends and family can have an impact on your physical health,” said lead investigator Janine Gronewold, PhD, of the University Hospital of Essen, in a statement. "What this study tells us is that having strong social relationships is of high importance for your heart health and similar to the role of classical protective factors such as having a healthy blood pressure, acceptable cholesterol levels, and a normal weight."

In order to further evaluate how different aspects of social relationships are associated with cardiovascular and overall health, Gronewold and a team of colleagues designed a study to assess these potential associations using data from the Heinz Nixdorf Recall study. The Heinz Nixdorf Recall study was a prospective, population-based study and provided investigators with data on a cohort of 4139 German participants without previous cardiovascular disease.

The mean age of this cohort was 59.1 (7.7) years, 46.7% were men, and the mean follow-up time was 13.4 years. Outcomes of interest for the analysis included incident fatal and non-fatal cardiovascular events as well as all-cause mortality.

For the purpose of their analysis, investigators assess the association of self-reported instrumental, emotional, and financial support and social integration at baseline with the aforementioned endpoints in a series of 5 multivariable Cox proportional hazards regression models.

The first model adjusted for age, sex, and social integration or social support. The second model adjusted for systolic blood pressure, LDL-C and HDL-C, glycated hemoglobin, BMI, antihypertensive medication, lipid-lowering medication, and antidiabetic medication. The third model accounted for variables from the second model plus alcohol consumption, smoking, and physical activity. The fourth model accounted for variables from the second model and income, education, and employment. The fifth model accounted for variables from the second model and depression, antidepressant use, and anxiolytic use.

Upon analysis, 339 cardiovascular events and 530 deaths were recorded during the follow-up period. After adjusting for other factors, investigators found lack of financial support was associated with a 30% (minimally adjusted HR, 1.30; 95% CI, 1.01-1.67) increase in risk of cardiovascular events. Results also revealed lack of social integration was associated with a decrease in risk of incident cardiovascular events (minimally adjusted HR, 1.44 (95% CI, 0.97-2.14) and with an increase in risk of all-cause mortality (minimally adjusted HR, 1.47; 95% CI, 1.09-1.97).

"We don't understand yet why people who are socially isolated have such poor health outcomes, but this is obviously a worrying finding, particularly during these times of prolonged social distancing," added Gronewold.

This study, “Association of social relationships with incident cardiovascular events and all-cause mortality,” was presented at EAN 2020 Virtual Congress.