Macy Baugh - Department of Cardiology
#loneliness #socialisolation #hearthealth #cardiovasculardisease #screening #heartfailure #patientoutcomes
While often used interchangeably, the terms ‘loneliness’ and ‘social isolation’ represent different concepts: social isolation refers to objective solitude with infrequent social connections, while loneliness is the subjective perception of being alone. It’s possible to feel lonely even if you have many social contacts, just like you can live a relatively isolated life and not feel alone. Despite the difference, both have been previously recognized as important risk factors for cardiovascular disease (CVD). However, less is known about their specific connection to heart failure (HF). To address this gap, a population-based cohort study was conducted to investigate the separate and combined associations of social isolation and loneliness with HF. Using self-reported questionnaires for assessment of social isolation and loneliness and linking hospital records and death registries for HF identification, the study revealed that both social isolation and loneliness independently correlated with higher rates of HF-related hospitalization or mortality. The association between social isolation and incident HF appeared to be influenced by loneliness status, indicating that subjective feelings of loneliness may outweigh the objective state of being alone in determining risk. Additionally, loneliness was found to increase HF risk even in individuals who are not socially isolated.
These findings indicate that the impact of subjective loneliness is more important than objective social isolation in relation to cardiovascular health. There are several potential explanations for these findings. Firstly, feeling lonely can induce chronic stress, which triggers release of stress hormones like cortisol and adrenaline. Prolonged exposure to these hormones can contribute to inflammation, elevated blood pressure, and increased heart rate, all of which can lead to impaired cardiovascular health. In addition, when people feel lonely, they may be more prone to engaging in unhealthy behaviors such as smoking, excessive drinking, overeating, or physical inactivity, all of which contribute to the development and exacerbation of CVD.
The findings of this study have direct implications for clinical practice – healthcare providers should recognize the importance of assessing not only objective social isolation, but also subjective feelings of loneliness in patients at risk for incident HF. Incorporating routine screening for loneliness could help identify these individuals. To improve cardiovascular health outcomes, we should implement interventions aimed at addressing loneliness and promoting socialization as part of comprehensive cardiovascular care.
References:
Liang YY;Chen Y;Feng H;Liu X;Ai QH;Xue H;Shu X;Weng F;He Z;Ma J;Ma H;Ai S;Geng Q;Zhang J; (n.d.). Association of Social Isolation and loneliness with incident heart failure in a population-based cohort study. JACC. Heart failure. https://pubmed.ncbi.nlm.nih.gov/36737310/
Edited By: Firas Batrash, Editor-in-Chief
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