• heart disease
• cardiac risk factors and prevention

Loneliness is an unpleasant emotional state induced by perceived isolation. Until about 200 years ago, the English word for being on one’s own was ‘oneliness’, a term that connoted solitude, and was generally considered an essential and positive experience in life. However, solitude and loneliness are not synonymous. Loneliness is also described as ‘social pain’ from an unwanted lack of connection and intimacy. Artists have likened loneliness to hunger, not only because we can feel it physically, sometimes described as an ache, a hollowness or a sense of coldness, but also because these physical sensations might be the body’s way of telling us that we are missing something that is important to our survival and flourishing.

In this issue of Heart, Bu and colleagues,1 in a prospective observational study that comprised approximately 5000 adults followed for about 10 years, found that individuals reporting high levels of loneliness had 30%–48% increased risks of developing cardiovascular disease (CVD) and CVD-related hospital admission, respectively, even after adjusting for the usual cardiovascular risk factors.1 This major study has three implications: (1) loneliness should be considered among the most dangerous CVD risk factors; (2) feeling lonely is a highly modifiable state that would seemingly respond to lifestyle adjustments as compared with the other foremost psychosocial CVD risk factors—depression and stress/anxiety—which typically require prescription medication or exercise2; and (3) social isolation without the anguish of loneliness does not appear to increase CVD risk.

The current study confirms prior data showing that self-reported loneliness is significantly correlated with increased healthcare utilisation and heightened morbidity and mortality risks.3 4 Advanced age, poor health, fewer …