Loneliness may contribute to heart disease risk for people with diabetes
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Key takeaways:
- Higher perceived loneliness scores were associated with CVD risk for people with diabetes.
- The predictive strength of loneliness for CVD was stronger than lifestyle risk factors.
Among people with diabetes, higher loneliness scores, but not isolation scores, were associated with greater risk for CVD, suggesting the quality but not quantity of relationships can impact disease risk, researchers reported.
In an analysis of more than 18,000 UK Biobank participants, researchers also found that perceived loneliness was a stronger predictor of CVD risk in people with diabetes than classic lifestyle factors, such as physical activity, diet, and alcohol consumption that are routinely incorporated in CV risk assessments.
Data were derived from Wang X, et al. Eur Heart J. 2023;doi:10.1093/eurheartj/ehad306.
“The quality of social contact appears to be more important for heart health in people with diabetes than the number of engagements,” Lu Qi, MD, PhD, FAHA, HCA Regents Distinguished Chair and professor in the department of epidemiology at Tulane University School of Public Health and Tropical Medicine, said in a press release. “We should not downplay the importance of loneliness on physical and emotional health. I would encourage patients with diabetes who feel lonely to join a group or class and try to make friends with people who have shared interests.”
Additive risk of loneliness, poor risk factor control
Qi and colleagues analyzed data from 18,509 adults with diabetes but no CVD at baseline who participated in the UK Biobank (mean age, 60 years; 40.2% women; 91% white). Participants completed a two-item scale to assess loneliness and a three-item scale to assess isolation level.
The loneliness scale was assessed through two questions: “Do you often feel lonely?” and “How often are you able to confide in someone close to you?” High-risk loneliness factors were defined as feeling lonely and being able to confide in someone less than once a month. The social isolation scale was measured with three questions: “Including yourself, how many people are living together in your household?”; “How often do you visit friends or family or have them visit you?”; and “Which of the following leisure/social activities do you engage in once a week or more often?” High-risk isolation factors were defined as living alone, having friends and family visit less than once a month, and no participating in social activity at least once per week. Researchers also assessed the degree of risk factor control by noting HbA1c, BP, LDL, smoking status and renal function.
The findings were published in the European Heart Journal.
Within the cohort, 61.1%, 29.6% and 9.3% participants were defined as having a loneliness scale of 0, 1 or 2, respectively. During a mean follow-up of 10.7 years, there were 3,247 CVD incidents, including 2,771 CHD incidents and 701 strokes.
In the fully adjusted model, compared with participants with the lowest loneliness score (0), HRs for CVD were 1.11 (95% CI, 1.02-1.2) and 1.26 (95% CI, 1.11-1.42) for participants with a loneliness score of 1 and 2, respectively (P for trend < .001). Researchers did not observe any associations between CVD incidence and social isolation scores.
Researchers also found that loneliness ranked higher in relative strength for predicting CVD than lifestyle risk factors, and there was an additive interaction between loneliness and the degree of risk factor control on CVD risk (P for additive interaction = .005).
“Specifically, if both loneliness and a low degree of risk factor control were present, this would result in an additional 8.5% of cases of CVD,” the researchers wrote. “The observed effect size of additive interaction in this study is modest in magnitude. However, given the high prevalence of diabetes and the increasing trend worldwide, such a percentage increase is considerable regarding the number of patients affected by CVD complications and therefore has important public health implications.”
Assess patients’ social relationships
In a related editorial, Kai G. Kahl, PhD, professor in the department of psychiatry, social psychiatry and psychotherapy at Hannover Medical School, Germany, and colleagues wrote that clinicians should consider incorporating assessments of social isolation and loneliness into standard clinical care when treating patients with CVD or at risk for it.
“While social isolation and perceived loneliness are complex constructs and various questionnaires are available, even as few as three questions for social isolation and two questions for loneliness may suffice,” Kahl and colleagues wrote. “We urge all health care professionals to treat social isolation and loneliness as the important biomarkers of CVD that they have been shown to be and refer respective patients to appropriate health care professionals.”
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