Social isolation and loneliness were associated with substantially increased risk of incident cardiovascular disease (CVD) among older women in the US, found a study in JAMA Network Open Journal.
Heart disease is the leading cause of death for American women, responsible for one in every five deaths, according to the US Centers for Disease Control and Prevention (CDC).
Now a study has found an almost 27% increase in heart disease risk in postmenopausal women who experience both high levels of social isolation and loneliness.
The findings revealed that social isolation and loneliness independently increased cardiovascular disease risk by 8% and 5%, respectively. If women experienced high levels of both, their risk rose 13% to 27%, compared with women who reported low levels of social isolation and low levels of loneliness.
“We are social beings. In this time of COVID-19, many people are experiencing social isolation and loneliness, which may spiral into chronic states,” said first author Natalie Golaszewski, PhD, a postdoctoral scholar at the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California San Diego.
“It is important to further understand the acute and long-term effects these experiences have on cardiovascular health and overall well-being,” she added
Importantly, social isolation and loneliness are mildly correlated and can occur at the same time, but they are not mutually exclusive. A socially isolated person is not always lonely and conversely, a person experiencing loneliness is not necessarily socially isolated.
“Social isolation is about physically being away from people, like not touching or seeing or talking to other people. Loneliness is a feeling, one that can be experienced even by people who are regularly in contact with others,” said senior author John Bellettiere, PhD, MPH, assistant professor of epidemiology at the Herbert Wertheim School of Public Health.
Social isolation and loneliness are growing public health concerns, associated with health conditions that increase the risk of cardiovascular disease including obesity, smoking, physical inactivity, poor diet, high blood pressure and high cholesterol.
When researchers included all of these health behaviours and conditions in their study and adjusted for diabetes and depression, high social isolation and loneliness remained strongly linked with increased risk for heart disease, supporting the importance of studying these social conditions.
As social networks shrink, older adults are more at risk of social isolation and loneliness, wrote the authors. One-fourth of adults 65 and older, report social isolation, and one-third of adults 45 or older report being lonely.
“We do not yet know whether the increased risk of cardiovascular disease is due to acute exposure to social isolation and loneliness or whether prolonged exposure accumulated over a lifetime is the culprit. Further studies are needed to better understand that,” said Bellettiere.
Previous research indicates women experience more social isolation than men. For this study, 57,825 postmenopausal women living in the United States who had previously participated in the Womenʼs Health Initiative study responded to questionnaires assessing social isolation from 2011 to 2012.
They were sent a second questionnaire assessing loneliness and social support from 2014 to 2015.
Participants were followed from the time of the questionnaire completion through to 2019 or when they were diagnosed with cardiovascular disease. A total of 1,599 women experienced the cardiovascular disease.
“Measures of social isolation and loneliness — even with brief questions as was done in our study — should be incorporated into standard care,” said Golaszewski.
“We monitor our patientsʼ blood pressure, weight and temperature, and it might also be beneficial to capture the social needs individuals may be lacking to better understand cardiovascular risk and develop solutions.”
Study details
Evaluation of Social Isolation, Loneliness, and Cardiovascular Disease Among Older Women in the US
Natalie Golaszewski, Andrea LaCroix, Job Godino, Matthew Allison, JoAnn. Manson, Jennifer King, Julie Weitlauf, Jennifer Bea, Lorena Garcia, Candyce Kroenke, Nazmus Saquib, Brad Cannell, Steve Nguyen, John Bellettiere.
Published in JAMA Network Open on 2 February 2022
Key Points
Question Are there associations between social isolation, loneliness, and cardiovascular disease (CVD) among older women?
Findings In this cohort study of 57,825 older women in the US, social isolation and loneliness were associated with an 8,0% and 5,0% higher risk for incident CVD, respectively, after adjusting for health behaviours and outcomes. Women with greater social isolation and greater loneliness had a 13,0% to 27,0% higher risk of incident CVD compared with women with less social isolation and less loneliness.
Meaning In this study, social isolation and loneliness were associated with increased risk of incident CVD among older women in the US, suggesting that interventions to reduce social isolation and loneliness in this population are warranted.
Abstract
Importance
Social isolation and loneliness are increasing public health concerns and have been associated with increased risk of cardiovascular disease (CVD) among older adults.
Objective
To examine the associations of social isolation and loneliness with incident CVD in a large cohort of postmenopausal women and whether social support moderated these associations.
Design, Setting, and Participants
This prospective cohort study, conducted from March 2011 through March 2019, included community-living US women aged 65 to 99 years from the Women’s Health Initiative Extension Study II who had no history of myocardial infarction, stroke, or coronary heart disease.
Exposures
Social isolation and loneliness were ascertained using validated questionnaires.
Main Outcomes and Measures
The main outcome was major CVD, which was physician adjudicated using medical records and included coronary heart disease, stroke, and death from CVD. Continuous scores of social isolation and loneliness were analysed. Hazard ratios (HRs) and 95% CIs for CVD were calculated for women with high social isolation and loneliness scores (midpoint of the upper half of the distribution) vs those with low scores (midpoint of the lower half of the distribution) using multivariable Cox proportional hazards regression models adjusting for age, race and ethnicity, educational level, and depression and then adding relevant health behaviour and health status variables. Questionnaire-assessed social support was tested as a potential effect modifier.
Results
Among 57 825 women (mean [SD] age, 79.0 [6.1] years; 89.1% white), 1599 major CVD events occurred over 186 762 person-years. The HR for the association of high vs low social isolation scores with CVD was 1.18 (95% CI, 1.13-1.23), and the HR for the association of high vs low loneliness scores with CVD was 1.14 (95% CI, 1.10-1.18). The HRs after additional adjustment for health behaviors and health status were 1.08 (95% CI, 1.03-1.12; 8.0% higher risk) for social isolation and 1.05 (95% CI, 1.01-1.09; 5.0% higher risk) for loneliness. Women with both high social isolation and high loneliness scores had a 13.0% to 27.0% higher risk of incident CVD than did women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations (social isolation × social support: r, –0.18; P = .86; loneliness × social support: r, 0.78; P = .48).
Conclusions and Relevance
In this cohort study, social isolation and loneliness were independently associated with modestly higher risk of CVD among postmenopausal women in the US, and women with both social isolation and loneliness had greater CVD risk than did those with either exposure alone. The findings suggest that these prevalent psychosocial processes merit increased attention for prevention of CVD in older women, particularly in the era of COVID-19.
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