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Original research article
Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women
  1. Christian Hakulinen1,2,
  2. Laura Pulkki-Råback1,
  3. Marianna Virtanen3,4,
  4. Markus Jokela1,
  5. Mika Kivimäki5,6,
  6. Marko Elovainio1,2
  1. 1 Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  2. 2 National Institute for Health and Welfare, Helsinki, Finland
  3. 3 Finnish Institute of Occupational Health, Helsinki, Finland
  4. 4 Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
  5. 5 Department of Epidemiology and Public Health, University College London, London, UK
  6. 6 Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  1. Correspondence to Dr Christian Hakulinen, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; christian.hakulinen{at}


Objective To examine whether social isolation and loneliness (1) predict acute myocardial infarction (AMI) and stroke among those with no history of AMI or stroke, (2) are related to mortality risk among those with a history of AMI or stroke, and (3) the extent to which these associations are explained by known risk factors or pre-existing chronic conditions.

Methods Participants were 479 054 individuals from the UK Biobank. The exposures were self-reported social isolation and loneliness. AMI, stroke and mortality were the outcomes.

Results Over 7.1 years, 5731 had first AMI, and 3471 had first stroke. In model adjusted for demographics, social isolation was associated with higher risk of AMI (HR 1.43, 95% CI 1.3 to –1.55) and stroke (HR 1.39, 95% CI 1.25 to 1.54). When adjusted for all the other risk factors, the HR for AMI was attenuated by 84% to 1.07 (95% CI 0.99 to 1.16) and the HR for stroke was attenuated by 83% to 1.06 (95% CI 0.96 to 1.19). Loneliness was associated with higher risk of AMI before (HR 1.49, 95% CI 1.36 to 1.64) but attenuated considerably with adjustments (HR 1.06, 95% CI 0.96 to 1.17). This was also the case for stroke (HR 1.36, 95% CI 1.20 to 1.55 before and HR 1.04, 95% CI 0.91 to 1.19 after adjustments). Social isolation, but not loneliness, was associated with increased mortality in participants with a history of AMI (HR 1.25, 95% CI 1.03 to 1.51) or stroke (HR 1.32, 95% CI 1.08 to 1.61) in the fully adjusted model.

Conclusions Isolated and lonely persons are at increased risk of AMI and stroke, and, among those with a history of AMI or stroke, increased risk of death. Most of this risk was explained by conventional risk factors.

  • cardiac risk factors and prevention
  • epidemiology
  • stroke

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  • Contributors CH and ME were responsible for the design of the study. CH conducted statistical analyses and wrote the first draft of the manuscript. All authors interpreted the data and critically revised the manuscript for important intellectual content. CH is the guarantor.

  • Funding This work was supported by the Academy of Finland (310591 to CH, 311492 to MK, 258598 and 292824 to MV), NordForsk (MK) and Helsinki Institute of Life Science fellowship (MK).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The UK Biobank study was approved by the NHS National Research Ethics Service (17 June 2011, Ref 11/NW/0382).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The present study has been conducted using the UK Biobank Resource (Application Number 14801) that is available to researchers (see

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