Are Social Isolation And Loneliness Associated With High Risks Of Heart Failure?

Although data are sparse, social isolation and loneliness are associated with increased risk of cardiac illnesses.

Social isolation and loneliness are found in all ages more so in the elderly population. Thus, they are associated with increased health problems. Studies show that there is a strong association between social relationships, socioeconomic status and cardiac and metabolic diseases. Loneliness and social isolation have negative influences on the health and are associated with poorer socioeconomic status and mental illness.

Social Isolation And Loneliness: Know The Difference

There is a difference between social isolation and feeling lonely. One who is socially isolated is one who lives alone and don’t participate in any community work and has relatively little or infrequent contacts with loved ones. Loneliness is where one feels emotionally disconnected from others. Particularly in men, it is found that loneliness and social isolation were more often associated with adverse health behaviour like tobacco use and obesity. When someone is lonely, they may turn to substances to pass the time or thrive in isolation.

Moreover, social isolation can cause increased inflammation and physiological symptoms of chronic stress like fatigue, sleep problems and weight gain which can give rise to atherosclerotic changes of arteries causing heart problems.

Limited physical activity may occur due to social isolation and loneliness because of decreased interaction with others leading to less going out and more inclination to spend time indoors. This sedentary lifestyle may increase the bad cholesterol in blood, thus increasing the risk of cardiac diseases.

How Social isolation and Loneliness Affect The Heart

Studies also examining prognostic effects of social isolation and loneliness following a cardiac illness like myocardial infarction was associated with increased morbidity and mortality. However, there is limited data supporting a causative association between social isolation and incident heart failure. Although Data are sparse, social isolation and loneliness are associated with increased risk of recurrent stroke and mortality.

If we look into the behavioural factors associated with isolation and loneliness, the behavioral factors are risks for developing cardiac illnesses are, besides smoking consists of greater sedentary time, less fruit and vegetables intake and other substance abuse. Other behavioural factors like medication adherence and health care use are also affected in social isolation and loneliness.

Besides being causes of cardiovascular diseases, social isolation and loneliness may be markers of these cardiac diseases. Data on the impact of social isolation on biomarkers of cardiovascular health are limited. Indicators of social connectedness like composite of marital status, contact with friends, and family, religious affiliations, religious and community affiliations has been associated with alteration on C- reactive protein levels and thus affect cardiac mortality. However, some studies have studied the longitudinal association between loneliness, social isolation with biomarkers of cardiovascular risk and results has been inconsistent. Several studies have however found that social isolation and loneliness is associated with short sleep duration and poor sleep quality among adults. A few studies have examined childhood social isolation and cardiovascular risk factors during adulthood. They have found that childhood social isolation is associated with cardiovascular risk factors such as overweight, hypertension, hemoglobin A1c levels and C reactive proteins.

Few studies have examined sex differences in the risk of social isolation or loneliness on cardiovascular health.

Interventions to Reduce Social Isolation and Loneliness

Studies on interventions to reduce social isolation and loneliness and to improve cardiac health are also limited. Of interventions to reduce social isolation, physical activity interventions like walking, stretching shows promise. Interventions for loneliness that address maladaptive social cognition, negative thoughts of self-worth and other people’s perception of the individual rather than interventions involving strengthening social support or increasing social interactions have been the most successful.

Dr Trideep Choudhury, Consultant Psychiatrist, Department of Mental Health and Behavioural Sciences, Fortis Flt. Lt Rajan Dhall Hospital Vasant Kunj, New Delhi.