Association between Social Isolation and Left Ventricular Mass

doi:10.1016/j.amjmed.2010.09.011

The American Journal of Medicine

Volume 124, Issue 2, February 2011, Pages 164-170

https://doi.org/10.1016/j.amjmed.2010.09.011 Get rights and content

Abstract

Background

Social isolation is associated with progression of cardiovascular disease, with the most socially isolated patients being at increased risk. Increased left ventricular mass is a predictor of cardiovascular morbidity and mortality. It is not yet clear whether social isolation is a determinant of increased left ventricular mass.

Methods

We performed a cross-sectional study of Northern Manhattan Study participants who were free of clinical cardiovascular disease and had obtained transthoracic echocardiograms (n = 2021) and a baseline questionnaire on social habits. Social isolation was defined as the lack of friendship networks (knowing fewer than 3 people well enough to visit within their homes). Echocardiographic left ventricular mass was indexed to height^2.7, analyzed as a continuous variable and compared between exposure groups.

Results

The prevalence of social isolation was 13.5%. The average left ventricular mass was significantly higher (50.2 gm/m^2.7) in those who were, as compared with those who were not (47.6 gm/m^2.7), socially isolated (P < .05). Higher prevalence of social isolation was found among those less educated, uninsured, or unemployed. There were no significant race-ethnic differences in the prevalence of social isolation. In multivariate analysis, there was a trend toward an association between social isolation and increased left ventricular mass in the total cohort (P = .09). Among Hispanics, social isolation was significantly associated with greater left ventricular mass. Hispanics who were socially isolated averaged 3.9 gm/ht^2.7 higher left ventricular mass compared with those not socially isolated (P = .002). This relationship was not present among non-Hispanic blacks or whites.

Conclusion

In this urban tri-ethnic cohort, social isolation was prevalent and associated with indices of low socioeconomic status. Hispanics who were socially isolated had a greater risk for increased left ventricular mass.

Section snippets

Study Population

The Northern Manhattan Study (NOMAS) is a population-based prospective cohort study of stroke-free individuals designed to investigate cardiovascular and stroke risk factors and prognosis in a multi-ethnic urban population of the northern Manhattan (New York) area. The methods of subject recruitment and enrollment into NOMAS have been described previously.4, 21, 22 Briefly, community subjects from northern Manhattan were eligible if they had never been diagnosed with a stroke, were ≥40 years of

Results

Table 1 describes the demographic characteristics and social resources of our cohort. Participants were primarily elderly, hypertensive, overweight, mostly uninsured, and with little education. There was a 13.5% prevalence of social isolation. Those socially isolated were significantly older, less educated, tended to be less insured or on Medicaid, and more likely to be unemployed or retired. There was a nonsignificant trend that those married tended to be less socially isolated. Details about

Discussion

A linear relationship between social support and health status has been well documented.11, 29, 30, 31 Social isolation has been shown to prospectively predict mortality and serious morbidity both in general population samples32, 33 and in individuals with established morbidity,³⁴ especially coronary heart disease.³⁵ However, our understanding of how and why social isolation is risky for health or, conversely, how and why social ties and relationships are protective of health, still remains

Conclusion

Our findings suggest that it may be important to try to ensure that all individuals, especially elderly individuals, have social ties with at least one or a few other individuals. This may mean the need to develop both individual and population-level strategies to identify individuals who are likely to be socially isolated. One such strategy is systematic screening by health care providers into the social components of the patient's lifestyle, with recommendations to become more involved in

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A systematic review of loneliness and social isolation among Hispanic/Latinx older adults in the United States
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Citation Excerpt :
Results from a study with 225 participants who were 50–68 years of age (M = 57.4, SD = 4.5) indicated that Hispanic/Latinx adults experience higher levels of loneliness than non-Hispanic White and Black adults (Hawkley et al., 2008). However, there are marked inconsistencies in results reporting the prevalence and associations of loneliness and social isolation in different racial/ethnic groups (Rodriguez et al., 2011; Taylor et al., 2019). It is possible that people living in individualistic cultures (e.g., United States, US, culture) are more likely to experience greater levels of loneliness than those living in collectivistic cultures, such as the Hispanic/Latinx culture in Latin America or Europe (Barreto et al., 2020).
Loneliness and social isolation are growing public health problems in older adults, associated with physical and mental comorbidity and increased mortality. In the United States, Hispanic/Latinx individuals constitute the largest racial/ethnic minority. Studies retrieved from PsycInfo, Embase, and PubMed were examined. The initial search yielded 1476 publications. Using the updated PRISMA Flow guidelines, a total of 17 studies met our review criteria. Eight studies assessed loneliness, six evaluated social isolation, and three investigated both. The reports varied in the details of methodology, preventing meta-analyses. Differences in the experience of loneliness and social isolation between Hispanic/Latinx and White adults are not consistent. Of the three studies of loneliness or social isolation among Hispanic/Latinx groups of different national origins, two reported significant differences. Loneliness was associated with greater overall comorbidity, but two studies found higher risk of metabolic and cardiovascular disorders in Hispanic/Latinx with loneliness. Social isolation was generally associated with worse physical health, being older, male, and unmarried, and having lower education and income, and more smoking, along with frailty and cognitive impairment. We make specific suggestions for future research on loneliness and social isolation in Hispanic/Latinx adults and offer guidelines for clinical management.
Educational status and differences in left ventricular mass and ejection fraction – The role of BMI and parameters related to the metabolic syndrome: A longitudinal analysis from the population-based CARLA cohort
2016, Nutrition, Metabolism and Cardiovascular Diseases
Citation Excerpt :
However, the explanatory effect of these factors on differences in cardiac mass or function between groups with different educational status remains largely unknown. Data from the United States indicate a higher left ventricular mass in socially isolated subjects [5] due to different habits in smoking and physical activity. In an earlier US-American study, left ventricular mass was higher among non-white subjects with a low socioeconomic status, while similar inverse relations between SES and left ventricular mass could not be shown for whites [6].
Higher ventricular mass has been reported in non-white US-Americans with low educational status and in socially isolated people. To assess the impact of education on cardiac mass and function in the general population and to identify mediators.
Data from a German population-based sample were used (CARLA cohort, n = 1779 at baseline, n = 1436 at the four-year follow-up). Ventricular mass indexed on height (LVMI) and ejection fraction, using Teichholz's formula (EFTZ), were measured. Education was assessed using the ISCED classification. Mediator analyses were performed using the R-macro ‘mediation’ to compute the average direct effect and the average causal mediated effect after confounder adjustment. Sensitivity analyses for unobserved confounders were performed. Considered mediators were BMI, waist-to-hip ratio, HbA1c, and systolic and diastolic blood pressures.
We found differences in LVMI and EFTZ, both at baseline and follow-up, between educational levels in women (lowest vs highest educational level: 15.6 g, 95% CI: −25.7, −5.6), but not in men. Similarly, women (lowest vs highest educational level at baseline: 3.3%, 95% CI: 0.8–5.7), but not men, of higher educational levels had a higher EFTZ of comparable magnitude at baseline and follow-up. Of the considered mediators, BMI explained 55.9% at baseline and 54.1% at follow-up of the educational effect, while other potential mediators had no significant effect. Relations remained constant between baseline and follow-up.
Women with low educational levels tend to have a higher ventricular mass and lower EF, which can be explained by a higher BMI in this group.
Social isolation, cognitive decline, and cardiovascular disease risk
2015, Current Opinion in Psychology
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In support of this, correlational studies with human participants have revealed that individuals with low social support have exaggerated heart rate and blood pressure responses to psychosocial stressors with a delay in recovery [47,48]. Socially isolated individuals also have autonomic imbalance [49], greater systemic inflammation [50], more profound left ventricular hypertrophy [51•], and increased coronary artery calcification (a marker of early atherosclerosis) [52•]. Taken together these findings support plausible biological mechanisms connecting social isolation to adverse neurological, physiological, and psychological reactions that may ultimately contribute to cardiovascular target organ damage and thus quantifiable decrements in cardiovascular health.
Some of the first observations in early psychology regarding human nature involved the importance of social connections to mental health. Humans are hypothesized to have a fundamental need to belong, which includes having meaningful, affectionate bonds from close relationships. Without such bonds humans are susceptible to psychological consequences, including negative affect and stress. Recently, research has begun to consider additional consequences of an unmet need to belong, including those impacting physiology, neurology, and physical health. Research employing animal models and human participants has provided converging evidence that social isolation is robustly and negatively associated with cognitive and cardiovascular function. In this review, we examine that evidence, review the possible mechanisms by which those associations form, and close by proposing avenues for future research to help elucidate these associations.
Social isolation and subclinical vascular pathways to cerebrovascular disease
2023, Biodemography and Social Biology
Social Connectivity is Related to Mild Cognitive Impairment and Dementia
2021, Journal of Alzheimer's Disease
On the Association Between Social Determinants of Health and Disability in Stroke-Free Older Adults Living in Rural Settings. The Three Villages Study
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: Funding: RLS, MSV (R01 NS29993), and MDT (K24 NS02241) are supported by the National Institute of Neurological Disorders and Stroke. CJR is supported by the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Award, and a National Heart, Lung, and Blood Institute Mentored Research Career Development Award (K23 HL079343-01A2).

: Conflict of Interest: The authors report no conflicts of interest.

: Authorship: The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All of the authors meet criteria for authorship, including acceptance of responsibility for the scientific content of the manuscript.

View full text

Clinical research studyAssociation between Social Isolation and Left Ventricular Mass

Abstract

Background

Methods

Results

Conclusion

Section snippets

Study Population

Results

Discussion

Conclusion

J Am Coll Cardiol

Am J Cardiol

Prev Med

Psychoneuroendocrinology

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Clin Epidemiol

Addict Behav

Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study

N Engl J Med

The relative effects of left ventricular hypertrophy, coronary artery disease, and ventricular dysfunction on survival among black adults

JAMA

Comparison of left ventricular mass and geometry in black and white patients with essential hypertension

Am J Hypertens

Relation between socioeconomic status, race-ethnicity, and left ventricular mass: the Northern Manhattan Study

Hypertension

Social Support and Cardiovascular Disease

Perception of social support and blood pressure in young men

Percept Mot Skills

Smoking, social support, and hassles in an urban African-American community

Am J Public Health

Social isolation of the urban poor: race, class, and neighborhood effects on social resources

Sociol Q

Social isolation in America

Am Sociol Rev

Stress-induced blood pressure reactivity and incident stroke in middle-aged men

Stroke

Does low socioeconomic status potentiate the effects of heightened cardiovascular responses to stress on the progression of carotid atherosclerosis?

Am J Public Health

Self-reported racism and social support predict blood pressure reactivity in blacks

Ann Behav Med

Gender, social support, and cardiovascular responses to stress

Psychosom Med

Modeling relationships among socioeconomic status, hostility, cardiovascular reactivity, and left ventricular mass in African American and white children

Health Psychol

Pathophysiological basis of ventricular hypertrophy

Eur Heart J

Clinical research study
Association between Social Isolation and Left Ventricular Mass