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Loneliness and isolation linked to increased heart disease/stroke risk

Effect size comparable to other recognised risk factors, such as anxiety and job stress

Caroline White

Wednesday, 20 April 2016

Loneliness and social isolation are linked to around a 30% increased risk of having a stroke or developing coronary artery disease, finds an analysis* of the available evidence, published online in the journal Heart.

The size of the effect is comparable to that of other recognised risk factors, such as anxiety and having a stressful job, the findings indicate, suggesting that it should be included in efforts to curb the risk of heart disease and stroke, say the researchers.

Loneliness has already been linked to various aspects of ill health and premature death, but it’s not clear what impact it might have on heart disease and stroke risk.

The researchers trawled 16 research databases for relevant studies, published up to May 2015, and found 23 that were eligible.

These studies, which involved more than 181,000 adults, included 4,628 coronary heart disease ‘events’ (heart attacks, angina attacks) and 3002 strokes recorded during monitoring periods, ranging from three to 21 years.

Analysis of the pooled data showed that loneliness/social isolation was associated with a 29% increased risk of a heart or angina attack and a 32% heightened risk of having a stroke.

The effect size was comparable to that of other recognised psychosocial risk factors, such as anxiety and a stressful job, the analysis indicated.

This is an observational study, so no firm conclusions can be drawn about cause and effect, added to which the researchers point out that it wasn’t possible to exclude the potential impact of other unmeasured factors or reverse causation.

Nevertheless, the findings back public health concerns about the importance of social contacts for health and wellbeing, they say.

“Our work suggests that addressing loneliness and social isolation may have an important role in the prevention of two of the leading causes of morbidity in high income countries,” they write.

In a linked editorial,** Drs Julianne Holt-Lunstad and Timothy Smith of Brigham Young University, Utah, USA, agree, pointing out social factors should be included in medical education, individual risk assessment, and in guidelines and policies applied to populations and health service delivery.

But one of the greatest challenges will be how to design effective interventions to boost social connections, taking account of technology, they say.

“With such rapid changes in the way people are interacting socially, empirical research is needed to address several important questions. Does interacting socially via technology reduce or replace face to face social interaction and/or alter social skills?” they ask.

“Given projected increases in levels of social isolation and loneliness in Europe and North America, medical science needs to squarely address the ramifications for physical health,” they write.

“Similar to how cardiologists and other healthcare professionals have taken strong public stances regarding other factors exacerbating [cardiovascular disease], e.g. smoking, and diets high in saturated fats, further attention to social connections is needed in research and public health surveillance, prevention and intervention efforts,” they conclude.

* Valtorta NK, et al. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart doi:10.1136/heartjnl-2015-308790

** Holt-Lunstad J, Smith TB. Loneliness and social isolation as risk factors for CVD: implications for evidence-based patient care and scientific inquiry. Heart doi:10.1136/heartjnl-2015-309242

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