Association of social relationships with incident cardiovascular events and all-cause mortality

Heart. 2020 Sep;106(17):1317-1323. doi: 10.1136/heartjnl-2019-316250. Epub 2020 Mar 12.

Abstract

Objective: To examine how different aspects of social relationships are associated with incident cardiovascular events and all-cause mortality.

Methods: In 4139 participants from the population-based Heinz Nixdorf Recall study without previous cardiovascular disease (mean (SD) age 59.1 (7.7) years, 46.7% men), the association of self-reported instrumental, emotional and financial support and social integration at baseline with incident fatal and non-fatal cardiovascular events and all-cause mortality during 13.4-year follow-up was assessed in five different multivariable Cox proportional hazards regression models: minimally adjusted model (adjusting for age, sex, social integration or social support, respectively); biological model (minimally adjusted+systolic blood pressure, low-density and high-density lipoprotein cholesterol, glycated haemoglobin, body mass index, antihypertensive medication, lipid-lowering medication and antidiabetic medication); health behaviour model (minimally adjusted+alcohol consumption, smoking and physical activity); socioeconomic model (minimally adjusted+income, education and employment); and depression model (minimally adjusted+depression, antidepressants and anxiolytics).

Results: 339 cardiovascular events and 530 deaths occurred during follow-up. Lack of financial support was associated with an increased cardiovascular event risk (minimally adjusted HR=1.30(95% CI 1.01 to 1.67)). Lack of social integration (social isolation) was associated with increased mortality (minimally adjusted HR=1.47 (95% CI 1.09 to 1.97)). Effect estimates did not decrease to a relevant extent in any regression model.

Conclusions: Perceiving a lack of financial support is associated with a higher cardiovascular event incidence, and being socially isolated is associated with increased all-cause mortality. Future studies should investigate how persons with deficient social relationships could benefit from targeted interventions.

Keywords: cardiac risk factors and prevention; epidemiology; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / mortality*
  • Cardiovascular Diseases / psychology
  • Female
  • Financial Support
  • Germany / epidemiology
  • Heart Disease Risk Factors
  • Humans
  • Incidence
  • Interpersonal Relations*
  • Male
  • Middle Aged
  • Prognosis
  • Risk Assessment
  • Social Behavior*
  • Social Determinants of Health*
  • Social Integration
  • Social Isolation
  • Social Support
  • Time Factors