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Cited by 21Health disparities and outcomesCardiac Health and Mental HealthDiabetes, Cardiovascular Risks, and Lipoproteins

Social isolation, loneliness and subsequent risk of major adverse cardiovascular events among individuals with type 2 diabetes mellitus

Open access
Liang, Yannis Yan, Chen, Yilin, Feng, Hongliang, Xue, Huachen, Nie, Yu, Ai, Qi‐Yong H, Ma, Jiacheng, Yang, Lulu +2 more·2023·General Psychiatry
DOI 10.1136/gpsych-2023-101153PMC PMC10759055
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Abstract

Background: Individuals with type 2 diabetes mellitus (T2DM) are more vulnerable to social disconnection compared with the general population; however, there are few relevant studies investigating this issue. Aims: To investigate whether social isolation or loneliness may be associated with subsequent risk of developing major adverse cardiovascular events, whether these associations vary according to fatal and non‐fatal outcomes and how behavioural, psychological and physiological factors mediate these associations. Methods: This longitudinal analysis included data from 19 360 individuals with T2DM at baseline (2006–2010) from the UK Biobank. Social isolation and loneliness were measured using self‐report questionnaires. The study outcomes included the first events of myocardial infarction (MI) or stroke (n=2273) and all‐cause (n=2820) or cardiovascular disease‐related mortality through linked hospital data or death registries. Results: Over a median follow‐up of 12.4 years (interquartile range (IQR): 11.6–13.3 years), participants who were more socially isolated (most social isolation vs least social isolation) experienced increased risks for all‐cause (hazard ratio (HR) : 1.33, 95% confidence interval (CI): 1.19 to 1.47) and cardiovascular disease (HR: 1.36, 95% CI: 1.17 to 1.59) mortality but not first MI or stroke. Loneliness (yes vs no) was associated with a greater risk for a composite of incident MI or stroke (HR: 1.37, 95% CI: 1.19 to 1.57) but not mortality. Social isolation was associated with fatal MI and stroke, whereas loneliness was associated with non‐fatal MI and stroke. The significant associations of social isolation and loneliness with outcomes were mainly mediated by behavioural factors (mediating proportion: 17.8%–28.2% and 17.6%–17.8%, respectively). Conclusions: Among individuals with T2DM, social isolation and loneliness are associated with a greater risk of developing major adverse cardiovascular events, with differences in both risks stratified according to fatal and non‐fatal events and underlying mediating factors.

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  1. [1]Wang F, Gao Y, Han Z, et al. A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality. Nat Hum Behav 2023; 7: 1307– 19. 10.1038/s41562-023-01617-6 37337095 · DOI
  2. [2]Xu X, Mishra GD, Holt-Lunstad J, et al. Social relationship satisfaction and accumulation of chronic conditions and multimorbidity: a national cohort of Australian women. Gen Psychiatr 2023; 36: e100925. 10.1136/gpsych-2022-100925 36844964 PMC9950967 · DOI
  3. [3]Schram MT, Assendelft WJJ, van Tilburg TG, et al. Social networks and type 2 diabetes: a narrative review. Diabetologia 2021; 64: 1905– 16. 10.1007/s00125-021-05496-2 34189591 PMC8241411 · DOI
  4. [4]Cené CW, Beckie TM, Sims M, et al. Effects of objective and perceived social isolation on cardiovascular and brain health: a scientific statement from the American heart Association. J Am Heart Assoc 2022; 11: e026493. 10.1161/JAHA.122.026493 35924775 PMC9496293 · DOI
  5. [5]Wang X, Chen J. Isolation and mental health: challenges and experiences from China. Gen Psychiatr 2021; 34: e100565. 10.1136/gpsych-2021-100565 34226883 PMC8238527 · DOI
  6. [6]Holt-Lunstad J, Perissinotto C. Social isolation and loneliness as medical issues. N Engl J Med 2023; 388: 193– 5. 10.1056/NEJMp2208029 36648080 · DOI
  7. [7]Smith RW, Barnes I, Green J, et al. Social isolation and risk of heart disease and stroke: analysis of two large UK prospective studies. Lancet Public Health 2021; 6: e232– 9. 10.1016/S2468-2667(20)30291-7 33662329 PMC7994247 · DOI
  8. [9]Wang X, Ma H, Li X, et al. Joint association of loneliness and traditional risk factor control and incident cardiovascular disease in diabetes patients. Eur Heart J 2023; 44: 2583– 91. 10.1093/eurheartj/ehad306 37385629 PMC10361009 · DOI
  9. [10]Liang YY, Chen Y, Feng H, et al. Association of social isolation and loneliness with incident heart failure in a population-based cohort study. JACC Heart Fail 2023; 11: 334– 44. 10.1016/j.jchf.2022.11.028 36737310 PMC9891238 · DOI
  10. [11]Chao AM, Wadden TA, Clark JM, et al. Changes in the prevalence of symptoms of depression, loneliness, and insomnia in U.S. older adults with type 2 diabetes during the COVID-19 pandemic: the look AHEAD study. Diabetes Care 2022; 45: 74– 82. 10.2337/dc21-1179 34753805 PMC8753763 · DOI
  11. [13]Henriksen RE, Nilsen RM, Strandberg RB. Loneliness increases the risk of type 2 diabetes: a 20 year follow-up - results from the hunt study. Diabetologia 2023; 66: 82– 92. 10.1007/s00125-022-05791-6 36168066 PMC9729154 · DOI
  12. [14]Santini ZI, Jose PE, York Cornwell E, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health 2020; 5: e62– 70. 10.1016/S2468-2667(19)30230-0 31910981 · DOI · Paper page
  13. [15]Shin SM, Oh TJ, Choi SH, et al. Effects of social distancing on diabetes management in older adults during COVID-19 pandemic. Diabetes Metab J 2021; 45: 765– 72. 10.4093/dmj.2021.0096 34461683 PMC8497936 · DOI
  14. [16]Brinkhues S, Dukers-Muijrers NHTM, Hoebe CJPA, et al. Social network characteristics are associated with type 2 diabetes complications: the Maastricht Study. Diabetes Care 2018; 41: 1654– 62. 10.2337/dc17-2144 29907582 · DOI
  15. [17]Miao Jonasson J, Hendryx M, Shadyab AH, et al. Social support, social network size, social strain, stressful life events, and coronary heart disease in women with type 2 diabetes: a cohort study based on the women's health initiative. Diabetes Care 2020; 43: 1759– 66. 10.2337/dc19-2065 32499383 PMC7372045 · DOI
  16. [18]Dunkler D, Kohl M, Heinze G, et al. Modifiable lifestyle and social factors affect chronic kidney disease in high-risk individuals with type 2 diabetes mellitus. Kidney Int 2015; 87: 784– 91. 10.1038/ki.2014.370 25493953 · DOI
  17. [19]Han H, Cao Y, Feng C, et al. Association of a healthy lifestyle with all-cause and cause-specific mortality among individuals with type 2 diabetes: a prospective study in UK Biobank. Diabetes Care 2022; 45: 319– 29. 10.2337/dc21-1512 34857534 · DOI · Paper page
  18. [20]Spencer-Bonilla G, Ponce OJ, Rodriguez-Gutierrez R, et al. A systematic review and meta-analysis of trials of social network interventions in type 2 diabetes. BMJ Open 2017; 7: e016506. 10.1136/bmjopen-2017-016506 PMC5629689 28827256 · DOI
  19. [21]Hughes ME, Waite LJ, Hawkley LC, et al. A short scale for measuring loneliness in large surveys: results from two population-based studies. Res Aging 2004; 26: 655– 72. 10.1177/0164027504268574 18504506 PMC2394670 · DOI · Paper page
  20. [22]Yu B, Steptoe A, Chen L-J, et al. Social isolation, loneliness, and all-cause mortality in patients with cardiovascular disease: a 10-year follow-up study. Psychosom Med 2020; 82: 208– 14. 10.1097/PSY.0000000000000777 31842061 · DOI · Paper page
  21. [23]Golaszewski NM, LaCroix AZ, Godino JG, et al. Evaluation of social isolation, loneliness, and cardiovascular disease among older women in the US. JAMA Netw Open 2022; 5: e2146461. 10.1001/jamanetworkopen.2021.46461 35107574 PMC8811637 · DOI
  22. [24]Hakulinen C, Pulkki-Råback L, Virtanen M, et al. Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women. Heart 2018; 104: 1536– 42. 10.1136/heartjnl-2017-312663 29588329 · DOI · Paper page
  23. [26]Brown V, Morgan T, Fralick A. Isolation and mental health: thinking outside the box. Gen Psychiatr 2021; 34: e100461. 10.1136/gpsych-2020-100461 34131627 PMC8149428 · DOI
  24. [28]Li H, Xia N. The role of oxidative stress in cardiovascular disease caused by social isolation and loneliness. Redox Biol 2020; 37: 101585. 10.1016/j.redox.2020.101585 32709420 PMC7767744 · DOI
  25. [30]Mund M, Freuding MM, Möbius K, et al. The stability and change of loneliness across the life span: a meta-analysis of longitudinal studies. Pers Soc Psychol Rev 2020; 24: 24– 52. 10.1177/1088868319850738 31179872 PMC6943963 · DOI · Paper page

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Authors
Liang, Y. Y., Chen, Y., Feng, H., Xue, H., Nie, Y., Ai, Q. H., Ma, J., Yang, L., Zhang, J., & Ai, S.
Affiliations
  • Guangdong Academy of Medical Sciences (CN)
  • Fudan University (CN)
  • Guangzhou Medical University (CN)
  • Hong Kong Polytechnic University (HK)
  • First Affiliated Hospital of Xinxiang Medical University (CN)
Corresponding author
Ai, Sizhi
ORCID
Venue
General Psychiatry
Publisher
Wiley
Published
2023-12
Volume
36
Issue
6
Pages
e101153-e101153
ISSN
  • 2096-5923 (ISSN-L)
  • 2517-729X
DOI
10.1136/gpsych-2023-101153
PMC
PMC10759055
OpenAlex
W4390277581
Cited by
21
References
5
Citations by year
2026: 11 · 2025: 5 · 2024: 5
FWCI
5.68
Type
journal article
Language
en
Open access
Licence
Locations
  • General Psychiatry (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • PolyU Institutional Research Archive (Hong Kong Polytechnic University) (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
Funders
  • National Natural Science Foundation of China (32100880)
  • Guangzhou Municipal Key Discipline in Medicine (NA)
  • Guangzhou Research-oriented Hospital (NA)
  • Guangzhou High-level Clinical Key Specialty (NA)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
social isolation, loneliness, type 2 diabetes, major adverse cardiovascular events, myocardial infarction, stroke, cardiovascular mortality, psychological factors, physiological factors

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