Effects of Objective and Perceived Social Isolation on Cardiovascular and Brain Health: A Scientific Statement From the American Heart Association

Abstract

Background Social isolation, the relative absence of or infrequency of contact with different types of social relationships, and loneliness (perceived isolation) are associated with adverse health outcomes. Objective To review observational and intervention research that examines the impact of social isolation and loneliness on cardiovascular and brain health and discuss proposed mechanisms for observed associations. Methods We conducted a systematic scoping review of available research. We searched 4 databases, PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health, and Scopus. Findings Evidence is most consistent for a direct association between social isolation, loneliness, and coronary heart disease and stroke mortality. However, data on the association between social isolation and loneliness with heart failure, dementia, and cognitive impairment are sparse and less robust. Few studies have empirically tested mediating pathways between social isolation, loneliness, and cardiovascular and brain health outcomes using appropriate methods for explanatory analyses. Notably, the effect estimates are small, and there may be unmeasured confounders of the associations. Research in groups that may be at higher risk or more vulnerable to the effects of social isolation is limited. We did not find any intervention studies that sought to reduce the adverse impact of social isolation or loneliness on cardiovascular or brain health outcomes. Conclusions Social isolation and loneliness are common and appear to be independent risk factors for worse cardiovascular and brain health; however, consistency of the associations varies by outcome. There is a need to develop, implement, and test interventions to improve cardiovascular and brain health for individuals who are socially isolated or lonely.

Association of Social Isolation and Loneliness With Incident Heart Failure in a Population-Based Cohort Study

“… 6 Several recent studies showed that both aspects of social disconnection, 20 , 24 , 25 social isolation only, 7 or loneliness only 8 , 26 were associated with the risk of incident CVD. These inconsistent findings were possibly caused by the variations in social network measurements, 3 age group, 7 sample size, and definition of the CVD across these studies. Our study offsets the limitations of some previous studies, such as having a limited number of HF events 7 or lack of direct comparisons of social isolation and loneliness in the same study setting.…”

“…1 Social isolation and loneliness have been recently recognized as important psychosocial determinants of cardiovascular diseases (CVDs), especially during the COVID-19 pandemic. 2 , 3 “Social isolation” refers to being objectively alone or having infrequent social connections, whereas “loneliness” is defined as a painful feeling caused by a discrepancy between one’s desire for connections and the actual degree of connections. 4 , 5 Despite compelling evidence linking social isolation and loneliness to multiple cardiovascular outcomes and premature mortality, less is known about their association with HF.…”

“…Limited evidence has supported a link between social isolation and incident HF, with inconclusive evidence. 3 , 6 , 7 Loneliness was showed to outweigh social isolation in increasing cardiovascular risk. 8 However, whether loneliness also contributes to the development of HF is uncertain.…”

Risk Factors Associated with Preventable Hospitalisation among Rural Community-Dwelling Patients: A Systematic Review

“…Otherwise referred to as distributed health literacy, a limited sphere of contact reduces the health literacy resources that can be used by patients, who themselves have low health literacy [ 73 ]. Compounding this further, isolation and loneliness can independently adversely affect their health [ 74 , 75 ]. Restrictions imposed during the COVID-19 pandemic highlighted the impact that isolation has on health outcomes [ 76 ], and provoked thought as to how isolated people can be reached and supported (e.g., telehealth) [ 76 , 77 , 78 , 79 , 80 ].…”

Social Isolation and Loneliness in Heart Failure

“…2 , 3 Social isolation and loneliness have increasingly been suggested as risk factors for cardiovascular disease. 4 …”