Physicians' Academy for Cardiovascular Education

Loneliness associated with higher CVD risk in DM

Joint association of loneliness and traditional risk factor control and incident cardiovascular disease in diabetes patients

Literature - Wang X, Ma H, Li X, et al. - Eur Heart J. 2023 Jul 21;44(28):2583-2591. doi: 10.1093/eurheartj/ehad306

Background

Loneliness and social isolation are both related to a higher risk of CVD [1-3]. Although patients with DM experience higher levels of loneliness and social isolation than individuals with no DM [4,5], little is known about the association of these factors with CVD risk in this patient population. It is also unclear whether the association between traditional risk factor control and CVD risk differs by the status of loneliness or social isolation.

Aim of the study

The authors investigated the prospective associations of loneliness and social isolation scores with CVD risk in DM patients and compared the relative importance of loneliness and social isolation in predicting CVD risk with that of traditional risk factors. Additionally, they evaluated the interactions of loneliness and isolation with the degree of traditional risk factor control in relation to CVD risk.

Methods

In this observational, population-based cohort study, data of 18,509 participants diagnosed with DM were extracted from the UK Biobank. Exclusion criteria were prevalent CHD, stroke, or HF. To assess loneliness, a 2-item scale was used, and a 3-item scale was used to measure levels of social isolation. The degree of traditional risk factor control was defined as the levels of HbA1c, blood pressure (BP), LDL-c, smoking status, and control of kidney condition. Mean follow-up time was 10.7 years.

Outcomes

The primary endpoints were total incident CVD events and its 2 major components (CHD events and stroke).

Main results

Association of loneliness or isolation scores with CVD risk

Relative importance of loneliness and isolation compared with other risk factors in predicting CVD risk

Joint association of loneliness and degree of risk factor control with CVD risk

Conclusion

This observational, population-based cohort study using UK Biobank data showed that loneliness, but not social isolation, was associated with a higher CVD risk in patients with DM. Loneliness ranked higher in relative strength for predicting CVD risk than lifestyle risk factors such as smoking, physical activity, and diet. In addition, the CVD risk associated with a combination of loneliness and a low degree of traditional risk factor control was greater than the addition of the risks associated with each of these factors. The authors conclude that their “results highlight the importance of loneliness in the prediction of CVDs among diabetic patients.”

References

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Find this article online at Eur Heart J.

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