Loneliness, Isolation May Increase CHD and Stroke Risk

Deborah Brauser

April 22, 2016

YORK, UK — Although past research has shown a link between impaired social relationships and premature mortality, a new meta-analysis suggests there may also be a significant association with increased risk for coronary heart disease (CHD) and stroke[1].

The review of 23 papers and 181,006 total patients showed a 29% increased risk for incident CHD for those who had poor social connections, shown through loneliness and social-isolation measurements, compared with those with better connections. The lonely and isolated patients also had a 32% increased risk for stroke.

The investigators, led by Dr Nicole K Valtorta (University of York, UK), note that loneliness often contributes to impaired coping methods, isolation affects self-efficacy, and both have been associated with decreased physical activity and increased smoking.

They add that future studies are needed to assess whether targeting these social characteristics "can help to prevent two of the leading causes of death and disability in high-income countries." But for now, "health practitioners have an important role to play in acknowledging the importance of social relations to their patients."

The findings were published online April 18, 206 in Heart.

In an accompanying editorial[2], Drs Julianne Holt-Lunstad and Timothy B Smith (both from Brigham Young University, Provo, UT) point out that the results "are consistent with substantial research indicating broad health risks" from poor quality and quantity of social connectivity.

With the new findings adding to the literature, and because of predicted increases in impaired social relationships throughout North America and Europe, "medical science needs to squarely address the ramifications for physical health," write the editorialists.

"Include Social Factors in Medical Training"

After examination of 16 health databases, the investigators' final review included 23 studies, with 4628 total CHD events and 3002 stroke events, and follow-ups ranging from 3 to 21 years. Of the studies examined, 18 had social-isolation measurements only, three had loneliness measurements, and two had measurements of both. Also, 18 studies measured CHD and 10 measured stroke—with five reporting on both.

In addition, each study in the current analysis had 98 to 47,713 participants.

The pooled relative risk (RR) for incident CHD was 1.29 for the participants who reported having high loneliness or social-isolation scores vs those with low scores (95% CI 1.0–1.6). There were no significant differences between those who reported just loneliness and those who reported just social isolation.

The association found between poor social relationships and CHD was "comparable in size to other recognized psychosocial risk factors, such as anxiety and job strain," note the researchers.

In addition, the RR for stroke for patients with poor social characteristics was 1.32 (95% CI 1.0–1.7).

"The cumulative evidence points to the benefit of including social factors in medical training and continuing education for healthcare professionals," write the editorialists.

They add that just as cardiologists and other clinicians "have taken strong public stances" when it comes to other CVD-exacerbating factors, "further attention to social connections is needed in research and public-health surveillance, prevention, and intervention efforts."

The study was funded by the National Institute for Health Research, Research Trainees Coordinating Center. The study authors and editorialists have disclosed no relevant financial relationships.

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