Social isolation and loneliness are associated with about a 30 percent increased risk of heart attack or stroke, or death from both, according to a new scientific statement from the American Heart Association published today in Journal of the American Heart Association, a peer-reviewed open-access journal of the American Heart Association. The statement also identified a lack of data on interventions that can improve cardiovascular health for people who are socially isolated or lonely.
“More than four decades of research have clearly shown that social isolation and loneliness are associated with adverse health outcomes,” said Crystal Wiley Sene, MD, MPH, FAHA, chair of the scientific statement writing group and professor of clinical medicine and chief administrative officer. health equity, diversity and inclusion officer at UC San Diego. “Given the prevalence of social isolation in the US, the public health impact is quite significant.”
The risk of social isolation increases with age due to life factors such as widowhood and retirement. Nearly a quarter of US adults age 65 and older are socially isolated, and the prevalence of loneliness is even higher, with estimates ranging from 22% to 47%. However, younger adults also experience social isolation and loneliness. A study by Harvard University’s Making Caring Common Project describes “Generation Z” (adults currently aged 18-22) as the loneliest generation. Increased isolation and loneliness among younger adults may be due to greater use of social media and less engagement in meaningful personal activities.
The data also suggest that social isolation and loneliness may have increased during the COVID-19 pandemic, particularly among young people aged 18-25, the elderly, women and people with low incomes.
Social isolation is defined as having infrequent personal contact with people for social relationships, such as family, friends, or members of the same community or religious group. Loneliness is when you feel alone or have less connection with others than you would like. “Although social isolation and loneliness are related, they are not the same thing,” Senne explains. “Individuals can lead relatively isolated lives and not feel lonely, and conversely, people with a lot of social contact can still experience loneliness.”
The writing team reviewed research on social isolation published through July 2021 to examine the relationship between social isolation and cardiovascular and brain health. They found:
- Social isolation and loneliness are common but under-recognized determinants of cardiovascular and brain health.
- Lack of social connection is associated with an increased risk of premature death from all causes, especially among men.
- Isolation and loneliness are associated with increased inflammatory markers, and people who are less socially connected are more likely to experience physiological symptoms of chronic stress.
- In assessing risk factors for social isolation, the relationship between social isolation and its risk factors goes both ways: depression can lead to social isolation, and social isolation can increase the likelihood of experiencing depression.
- Social isolation during childhood is associated with increased cardiovascular risk factors in adulthood, such as obesity, high blood pressure and elevated blood sugar levels.
Socio-environmental factors including transport, living conditions, dissatisfaction with family relationships, pandemics and natural disasters are also factors that affect social connections.
There is strong evidence linking social isolation and loneliness to an increased risk of poor heart and brain health in general; however, data on the association with certain outcomes, such as heart failure, dementia, and cognitive impairment, are scarce.”
Crystal Wiley Cené, MD, MPH, FAHA, Scientific Statement Writing Group Chair
The evidence is most consistent for the link between social isolation, loneliness and death from heart disease and stroke, with a 29% increased risk of heart attack and/or death from heart disease and a 32% increased risk of stroke and death from stroke. “Social isolation and loneliness are also associated with a worse prognosis in people who already have coronary heart disease or stroke,” added Cené.
People with heart disease who were socially isolated had a two- to threefold increase in mortality during a six-year follow-up study. Socially isolated adults with three or fewer social contacts per month may have a 40% increased risk of recurrent stroke or heart attack. In addition, 5-year heart failure survival was lower (60%) for people who were socially isolated and for those who were both socially isolated and clinically depressed (62%) compared to those , who have more social contacts and are not depressed (79%).
Social isolation and loneliness are also associated with behaviors that negatively impact cardiovascular and brain health, such as lower levels of physical activity, less fruit and vegetable intake, and more sedentary time. Multiple large studies have found significant associations between loneliness and a greater likelihood of smoking.
“There is an urgent need to develop, implement and evaluate programs and strategies to reduce the negative effects of social isolation and loneliness on cardiovascular and brain health, especially for at-risk groups,” Sene said. “Clinicians should ask patients about the frequency of their social activity and whether they are satisfied with their level of interaction with friends and family. They should then be prepared to refer people who are socially isolated or lonely -; especially those with a history of heart disease or stroke -; to community resources to help them connect with others.”
Certain populations are more vulnerable to social isolation and loneliness, and more research is needed to understand how social isolation affects cardiovascular and brain health in these groups, including children and young adults, people from underrepresented racial and ethnic groups, lesbian, gay, bisexual, transgender and queer (LGBTQ) people, people with physical disabilities, people with hearing or vision impairment, people living in rural areas and under-resourced communities, people with limited access to technology and internet services , recent immigrants and incarcerated persons.
The review highlights research among older people aimed at reducing social isolation and loneliness. These studies found that fitness programs and recreational activities in senior centers, as well as interventions targeting negative self-esteem and other negative thoughts, have shown promise in reducing isolation and loneliness.
The review did not identify any research aimed at reducing social isolation with the specific aim of improving cardiovascular health.
“It is not clear whether actual isolation (social isolation) or the feeling of isolation (loneliness) is most important for cardiovascular and brain health, as only a few studies have examined both in the same sample,” said Sene. “More research is needed to examine the associations between social isolation, loneliness, coronary heart disease, stroke, dementia and cognitive impairment, and to better understand the mechanisms by which social isolation and loneliness affect cardiovascular and brain health outcomes.”
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Committee on Social Determinants of Health of the Council on Epidemiology and Prevention and the Council on Care Quality and Outcomes Research; The Scientific Committee on Prevention of the Council on Epidemiology and Prevention and the Council on Care Quality and Outcomes Research; The Scientific Committee on Prevention of the Council on Epidemiology and Prevention and the Council on Cardiovascular Disease and Stroke Nursing; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and the Stroke Council.
American Heart Association
Dear CW, and others. (2022) Effects of Objective and Perceived Social Isolation on Cardiovascular and Brain Health: A Scientific Statement from the American Heart Association. Journal of the American Heart Association. doi.org/10.1161/JAHA.122.026493.