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Loneliness itself appears not to raise risk of heart attack/stroke

Social isolation still linked to death in people with pre-existing heart disease

Adrian O'Dowd

Tuesday, 27 March 2018

Loneliness on its own does not appear to be the main cause of having a higher risk of first-time heart disease/stroke, suggests the largest study* of its kind published online today in the journal Heart.

Researchers found that conventional risk factors largely explained the links observed between loneliness/social isolation and first-time heart disease/stroke, but having few social contacts still remained an independent risk factor for death among people with pre-existing heart disease.

Previous research has highlighted links between loneliness and social isolation and cardiovascular disease and death, but most of these studies have not considered a wide range of other potentially influential factors.

Therefore, an international team of researchers led by Dr Christian Hakulinen of the University of Helsinki, Finland, set out to clarify what role these other factors might have.

They used data from 479,054 people aged between 40 and 69, who were all part of the UK Biobank study between 2007 and 2010.

Participants provided information on their ethnic background, educational attainment, household income, lifestyle (smoking, drinking, exercise) and depressive symptoms.

They were also asked a series of questions to gauge their levels of social isolation and loneliness. For the study, their health was then tracked for an average of seven years.

Around a tenth (9%) of respondents were deemed to be socially isolated, 6% lonely, and 1% both.

Those who were socially isolated and/or lonely were more likely to have other underlying long-term conditions and to be smokers, while those who were lonely reported more depressive symptoms.

During the seven-year monitoring period, 12,478 people died, while 5,731 people had a first-time heart attack and 3,471 had a first-time stroke.

The researchers calculated that social isolation was associated with a 43% higher risk of first-time heart attack, when age, sex, and ethnicity were factored in.

However, when behavioural, psychological, health, and socioeconomic factors were added into the mix, these factors accounted for most (84%) of the increased risk, and the initial association was no longer significant.

Similarly, social isolation was initially associated with a 39% heightened risk of a first-time stroke, but the other conventional risk factors accounted for 83% of this risk.

Similar results were observed for loneliness and risk of first time heart attack or stroke.

Analysis showed that this was not the case for people with pre-existing heart disease.

Given that this was an observational study, no firm conclusions can be drawn about cause and effect, but the findings echo those of other research in the field, said the study authors.

They concluded: “These findings indicate that social isolation, similarly to other risk factors such as depression, can be regarded as a risk factor for poor prognosis of individuals with cardiovascular disease.

“Targeting conventional risk factors could reduce cardiovascular disease burden among isolated and lonely individuals.”

Professor Helen Stokes-Lampard, RCGP chair said: “On the frontline, GPs and our teams report seeing patients on a daily basis whose underlying problems are not primarily medical, but who are feeling socially isolated or lonely.

“In response, many practices are referring patients to social prescribing schemes, for example referring patients to local activities, coffee mornings, or signing them up to surgery-run initiatives like walking groups. We need a community-wide approach to address this growing challenge.”

*Hakulinen C, Pulkki-Råback L, Virtanen M, et al. Social isolation and loneliness as risk factors for myocardial infarction, stroke, and mortality: UK Biobank cohort study of 479 054 men and women. DOI:10.1136/heartjnl-2017-312663

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