Loneliness and Heart Disease

“Solitude is not the same as loneliness. Solitude is a solitary boat floating in a sea of possible companions.” Robert Fulgham

We are, at our core, social animals. A new report, from DenHeart, a Danish study of heart disease, adds to that belief. All patients, discharged from heart centers, over a one year period, were asked about their living situation, the usual demographics, and a question about loneliness; “Does it ever happen that you are alone even though you would prefer to be with other people?” An affirmative answer modified by often or sometimes was a yes.

About half of the patients completed the survey, roughly 13,500. Patients reported their symptoms and outcomes, but to reduce recall bias, survey results were obtained within a few days of hospital discharge. Subsequent cardiac events or mortality came from a national registry.

• For both men and women, living alone was associated with a reduced risk of anxiety symptoms. On the other hand, loneliness was associated with greater anxiety, depression, quality of life for both genders; and the effect was 3-fold higher than living alone.
• Lonely women had almost a 3-fold increase in all-cause mortality; men a 2-fold increase.

Loneliness does influence prognosis, a fact demonstrated by this and previous studies. But some of the more interesting data lies in the variables associated with loneliness. Of course, the most obvious is that living alone is not the equivalent, but remains a factor. Living alone was perhaps a precondition, but not a necessity. Nor was marriage a guarantee of companionship. 33% of women and 45% of men were lonely, despite living with their spouse. Widows were twice as likely to feel isolated as widowers.

Comorbidities, lifestyle, and the underlying forms of heart disease also played a role, and the previously cited numbers reflect an adjustment for those conditions. While the study does not demonstrate causality, it is fair to say that loneliness does impair prognosis.

There are some instances where living with another can be stressful, consider the multitude of spouse-caregivers for patients with Alzheimer’s, heart failure, or the need for dialysis. Perhaps that explains in part why living alone makes some people feel less anxious. Women have more extensive and often more resilient social networks than men, so maybe men have developed a higher threshold for feeling alone. And while this is all conjecture, the one point that shines through is that to be as functional as possible, we need social relations. The demise of the now historical nuclear family continues to reverberate in our health. As our population continues to dramatically age, companionship will join the other social determinants of health.

Source: Significantly increased risk of all-cause mortality among cardiac patients feeling lonely Heart DOI: 10.1136/heartjnl-2019-315460