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Social isolation, vital exhaustion, and incident heart failure: findings from the Atherosclerosis Risk in Communities Study.

TitleSocial isolation, vital exhaustion, and incident heart failure: findings from the Atherosclerosis Risk in Communities Study.
Publication TypeJournal Article
Year of Publication2012
AuthorsCené CW, Loehr LR, Lin F-C, Hammond W P, Foraker RE, Rose K, Mosley T
Secondary AuthorsCorbie-Smith G
JournalEur J Heart Fail
Volume14
Issue7
Pagination748-53
Date Published2012 Jul
ISSN1879-0844
KeywordsAdaptation, Psychological, Arteriosclerosis, Chi-Square Distribution, Confidence Intervals, Fatigue, Female, Heart Failure, Humans, Incidence, Male, Middle Aged, Prospective Studies, Residence Characteristics, Risk Factors, Stress, Psychological, Surveys and Questionnaires, United States
Abstract

AIMS: Prospective studies have shown that social isolation (i.e. lack of social contacts) predicts incident coronary heart disease (CHD), but it is unclear whether it predicts incident heart failure (HF) and what factors might mediate this association. HF patients may be more susceptible to social isolation as they tend to be older and may have disrupted social relationships due to life course factors (e.g. retirement or bereavement). We prospectively examined whether individuals with higher vs. low social isolation have a higher incidence of HF and determined whether this association is mediated by vital exhaustion.

METHODS AND RESULTS: We estimated incident HF hospitalization or death among 14 348 participants from Visit 2 (1990-1992) in the Atherosclerosis Risk in Communities (ARIC) study using Cox proportional hazard models which were sequentially adjusted for age, race/study community, gender, current smoking, alcohol use, and co-morbidities. We conducted mediation analyses according to the Baron and Kenny method. After a median follow-up of 16.9 person-years, 1727 (13.0%) incident HF events occurred. The adjusted hazard of incident HF was greater for those in the higher vs. low social isolation risk group (hazard ratio 1.21, 95% confidence interval 1.08-1.35). Our data suggest that vital exhaustion strongly mediates the association between higher social isolation and incident HF (the percentage change in beta coefficient for higher vs. low social isolation groups after adjusting for vital exhaustion was 36%).

CONCLUSION: These data suggest that greater social isolation is an independent risk factor for incident HF, and this association appears to be strongly mediated by vital exhaustion.

DOI10.1093/eurjhf/hfs064
Alternate JournalEur J Heart Fail
PubMed ID22588323
PubMed Central IDPMC3380545
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HHSN268201100005C / / PHS HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100009C / / PHS HHS / United States
K23HL107614 / HL / NHLBI NIH HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
K24 HL105493 / HL / NHLBI NIH HHS / United States
HHSN268201100010C / / PHS HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / / PHS HHS / United States
HHSN268201100012C / / PHS HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
HHSN268201100007C / / PHS HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100011C / / PHS HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
UL1RR025747 / RR / NCRR NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States
HHSN268201100006C / / PHS HHS / United States
K23 HL107614 / HL / NHLBI NIH HHS / United States
KL2RR025746 / RR / NCRR NIH HHS / United States