Heart Failure
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A new study published yesterday in JACC: Heart Failure by researchers in China shows that social isolation and loneliness are associated with higher rates of heart failure. However, whether a person feels lonely regardless if they are alone or not is more important in determining risk. The new study helps bridge the gap between previous research which has shown that social isolation and loneliness are risk factors for the development cardiovascular disease and the connection to heart failure.

Both social isolation and loneliness are categorized as forms of social disconnection, but have differing components. Social isolation is defined as objectively being alone and having few social connections, while loneliness is defined by the painful emotions that accompany a person’s level of social interaction less than what they would like it to be.

Data used for the study came from the UK Biobank comprising more than 400,000 middle-aged and older adults whose health outcomes were collected longitudinally over a period of 12 years. The investigators assessed psychosocial factors such as isolation and loneliness via self-reported questionnaires. According to senior author Jihui Zhang, MD, PhD, of Guangzhou Medical University in China, previous studies seeking insight to the effects of social isolation and loneliness have provided inclusive findings due to the different measurements used to define the two conditions.

In the new study, the researchers found an increased risk of between 15 to 20 percent of heart failure in patients who experienced social isolation or loneliness. Importantly, the study also revealed that social isolation was only a risk factor in the absence of loneliness. So if a person reported as both socially isolated and lonely, then loneliness was the driving factor in increased heart failure risk. Loneliness was also shown to increase risk even if the person was not socially isolated. Both conditions were more likely in men than in women and were also associated with adverse health behaviors including smoking and obesity.

“These findings indicate that the impact of subjective loneliness was more important than that of objective social isolation,” said Zhang. “These results suggest that when loneliness is present, social isolation is no more important in linking with heart failure. Loneliness is likely a stronger psychological stressor than social isolation because loneliness is common in individuals who are hostile or have stressful social relationships.”

He further noted that these new findings have added relevance as the COVID-19 pandemic has underscored the adverse effects on health that have come to light as a result of periods of social isolation and loneliness during the pandemic.

In an editorial in today’s journal reflecting on these findings, Sarah J. Goodlin, MD, researcher at Patient-Centered Education and Research, and Sheldon Gottlieb, MD, associate professor of medicine at Johns Hopkins University School of Medicine noted that a person’s socioeconomic status can be a factor that leads to social isolation and loneliness.

“The relationship with social isolation and loneliness is probably strongest in persons at extremes of social isolation and loneliness and compounded by low socioeconomic status,” they wrote. “Because social determinants of health are increasingly recognized as important components of patient-centered health care, it may be appropriate to incorporate specific interventions, such as ‘social prescribing’ into care.”

Additional next steps planned by the researchers include investigating the effects the two factors play in determining major health outcomes in vulnerable populations, such as those people with type 2 diabetes. The team is also delving into better understanding how the exact mechanisms caused by social isolation and loneliness affect cardiovascular health and lead to heart failure.

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