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Loneliness and social isolation are associated with an increased risk of premature mortality. This association is related to several factors including behaviors (such as smoking or physical inactivity), reduced psychological well-being, and adverse physiological changes (such as altered immune function and hypertension). In order to better define the magnitude of risk for incident cardiovascular disease attributable to loneliness and social isolation, Valtorta and colleagues (see page 1009) performed a meta-analysis of 16 longitudinal databases with a total of 4628 coronary heart disease (CHD) events and 3002 strokes over 3 to 21 years of follow-up. This analysis showed that loneliness and social isolation were associated with a 29% increased risk of CHD (figure 1) and 32% increased risk of stroke, with no differences by gender. While acknowledging that causality cannot be inferred from an association study, the authors suggest that “tackling loneliness and isolation may be a valuable addition to CHD and stroke prevention strategies. Health practitioners have an important role to play in acknowledging the importance of social relations to their patients”.
In a linked editorial, Holt-Lunstad and Smith (see page 987) provide insight into the likely biological mechanisms underlying this association (figure 2). Further, they emphasize that this association in not simply due to established cardiovascular risk factors: “Taken together, these latest findings specific to loneliness and isolation bolster the already robust evidence documenting that social connections significantly predict morbidity and mortality, supporting the case for inclusion as a risk factor for cardiovascular disease”. Potential …
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