Skip to main content
SpringerLink
Log in

Social Isolation, Loneliness, and Cardiovascular Mortality: The Role of Health Care System Interventions

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The world is proliferating rapidly, with science and technology advancing at an incredible rate. These advances have, however, ushered in an age with a rise in social isolation (SI) and loneliness. SI is an objective term that refers to lacking social contact or support. On the other hand, loneliness is subjective and refers to feeling alone or isolated. These concepts are rapidly gaining prominence mainly due to their negative impact on the physical and psychological health of the population, mainly through behavioural modifications that encompass substance abuse, decreased physical activity and unhealthy food habits, and poor sleep hygiene. This review summarizes the pathophysiology, evaluates the evidence behind impact of SI on cardiovascular mortality, and interventions to overcome SI.

Recent Findings

Through proposed mechanisms, such as activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, both SI and loneliness have strong evidence linking them to cardiovascular morbidity and mortality. A systematic review and meta-analysis of 90 prospective cohort studies including 2,205,199 individuals reported that SI was independent predictor of cardiovascular mortality with a point estimate of 1.34 (95% confidence interval:1.25–1.44).

Summary

The evidence so far is compelling and necessitates urgent action with the implementation of strict policies to tackle this issue. As healthcare professionals, it becomes even more critical to remain vigilant, recognize this insidious pandemic, and take appropriate action.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol. 1980;39(3):472–80.

    Article  CAS  PubMed  Google Scholar 

  2. Berg S, Mellström D, Persson G, Svanborg A. Loneliness in the Swedish Aged1. J Gerontol. 1981;36(3):342–9.

    Article  CAS  PubMed  Google Scholar 

  3. Holmén K, Ericsson K, Andersson L, Winblad B. Loneliness among elderly people living in Stockholm: a population study. J Adv Nurs. 1992;17(1):43–51.

    Article  PubMed  Google Scholar 

  4. Theeke LA. Predictors of loneliness in U.S. adults over age sixty-five. Arch Psychiatr Nurs. 2009;23(5):387–96.

    Article  PubMed  Google Scholar 

  5. Hansen T, Slagsvold B. Late-life loneliness in 11 european countries: results from the generations and gender survey. Soc Indic Res. 2016;129(1):445–64.

    Article  Google Scholar 

  6. Rico-Uribe LA, Caballero FF, Olaya B, Tobiasz-Adamczyk B, Koskinen S, Leonardi M, et al. Loneliness, social networks, and health: a cross-sectional study in three countries. PLoS ONE. 2016;11(1):e0145264.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Beutel ME, Klein EM, Brähler E, Reiner I, Jünger C, Michal M, et al. Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry. 2017;17(1):97.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Luhmann M, Hawkley LC. Age differences in loneliness from late adolescence to oldest old age. Dev Psychol. 2016;52(6):943–59.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cacioppo S, Grippo AJ, London S, Goossens L, Cacioppo JT. Loneliness: clinical import and interventions. Perspect Psychol Sci. 2015;10(2):238–49.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cacioppo S, Cacioppo JT. Why may allopregnanolone help alleviate loneliness? Med Hypotheses. 2015;85(6):947–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Cacioppo JT, Cacioppo S, Cole SW, Capitanio JP, Goossens L, Boomsma DI. Loneliness across phylogeny and a call for comparative studies and animal models. Perspect Psychol Sci. 2015;10(2):202–12.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Völker B. Networks in lockdown: the consequences of COVID-19 for social relationships and feelings of loneliness. Soc Networks. 2023;72:1–12.

    Article  PubMed  Google Scholar 

  13. Bu F, Zaninotto P, Fancourt D. Longitudinal associations between loneliness, social isolation and cardiovascular events. Heart. 2020;106(18):1394–9.

    Article  PubMed  Google Scholar 

  14. • Wang F, Gao Y, Han Z, Yu Y, Long Z, Jiang X, et al. A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality. Nat Hum Behav. 2023;7(8):1307–19. A meta-analysis indicating the impact of social isolation of all cause as well cardiovascular mortality.

    Article  PubMed  Google Scholar 

  15. Booth J, Connelly L, Lawrence M, Chalmers C, Joice S, Becker C, et al. Evidence of perceived psychosocial stress as a risk factor for stroke in adults: a meta-analysis. BMC Neurol. 2015;15:233.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–62.

    Article  PubMed  Google Scholar 

  17. Moore L, Meyer F, Perusse M, Cantin B, Dagenais GR, Bairati I, et al. Psychological stress and incidence of ischaemic heart disease. Int J Epidemiol. 1999;28(4):652–8.

    Article  CAS  PubMed  Google Scholar 

  18. Kershaw KN, Brenes GA, Charles LE, Coday M, Daviglus ML, Denburg NL, et al. Associations of stressful life events and social strain with incident cardiovascular disease in the Women’s Health Initiative. J Am Heart Assoc. 2014;3(3):e000687.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hollis JF, Connett JE, Stevens VJ, Greenlick MR. Stressful life events, Type A behavior, and the prediction of cardiovascular and total mortality over six years. MRFIT Group J Behav Med. 1990;13(3):263–80.

    Article  CAS  PubMed  Google Scholar 

  20. Berntson J, Patel JS, Stewart JC. Number of recent stressful life events and incident cardiovascular disease: moderation by lifetime depressive disorder. J Psychosom Res. 2017;99:149–54.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Theorell T, Lind E, Flodérus B. The relationship of disturbing life-changes and emotions to the early development of myocardial infarction and other serious illnesses. Int J Epidemiol. 1975;4(4):281–93.

    Article  CAS  PubMed  Google Scholar 

  22. Kornerup H, Osler M, Boysen G, Barefoot J, Schnohr P, Prescott E. Major life events increase the risk of stroke but not of myocardial infarction: results from the Copenhagen City Heart Study. Eur J Cardiovasc Prev Rehabil. 2010;17(1):113–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lima LR, Ponte P, Dias LN, Silvestre MHL, Suen PJC, Mansur AP. Social isolation, hospitalization, and deaths from cardiovascular diseases during the COVID-19 epidemic in São Paulo Metropolitan Area in 2020. Int J Environ Res Public Health. 2022;19(17):11002. https://doi.org/10.3390/ijerph191711002.

  24. Sayin Kasar K, Karaman E. Life in lockdown: Social isolation, loneliness and quality of life in the elderly during the COVID-19 pandemic: a scoping review. Geriatr Nurs. 2021;42(5):1222–9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Costa JA, Silveira JA, Santos S, Nogueira PP. Cardiovascular implications in patients infected with COVID-19 and the importance of social isolation to reduce dissemination of the disease. Arq Bras Cardiol. 2020;114(5):834–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Peçanha T, Goessler KF, Roschel H, Gualano B. Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease. Am J Physiol Heart Circ Physiol. 2020;318(6):H1441–6.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227–37.

    Article  PubMed  Google Scholar 

  28. Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102(13):1009–16.

    Article  CAS  PubMed  Google Scholar 

  29. Hawkley LC, Masi CM, Berry JD, Cacioppo JT. Loneliness is a unique predictor of age-related differences in systolic blood pressure. Psychol Aging. 2006;21(1):152–64.

    Article  PubMed  Google Scholar 

  30. Hawkley LC, Thisted RA, Masi CM, Cacioppo JT. Loneliness predicts increased blood pressure: 5-year cross-lagged analyses in middle-aged and older adults. Psychol Aging. 2010;25(1):132–41.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kaplan JR, Manuck SB, Clarkson TB, Lusso FM, Taub DM, Miller EW. Social stress and atherosclerosis in normocholesterolemic monkeys. Science. 1983;220(4598):733–5.

    Article  CAS  PubMed  Google Scholar 

  32. Bains KK, Turnbull T. Improving health outcomes and serving wider society: the potential role of understanding and cultivating prosocial purpose within health psychology research and practice to address climate change and social isolation and loneliness. Front Psychol. 2019;10:1787.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Li H, Xia N. The role of oxidative stress in cardiovascular disease caused by social isolation and loneliness. Redox Biol. 2020;37:101585.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Shively CA, Clarkson TB, Kaplan JR. Social deprivation and coronary artery atherosclerosis in female cynomolgus monkeys. Atherosclerosis. 1989;77(1):69–76.

    Article  CAS  PubMed  Google Scholar 

  35. Cené CW, Beckie TM, Sims M, Suglia SF, Aggarwal B, Moise N, 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(16):e026493.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hickin N, Käll A, Shafran R, Sutcliffe S, Manzotti G, Langan D. The effectiveness of psychological interventions for loneliness: a systematic review and meta-analysis. Clin Psychol Rev. 2021;88:102066.

    Article  PubMed  Google Scholar 

  37. Stavrova O, Ren D. Alone in a crowd: is social contact associated with less psychological pain of loneliness in everyday life? J Happiness Stud. 2023;24(5):1841–60.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Morrish N, Choudhury S, Medina-Lara A. What works in interventions targeting loneliness: a systematic review of intervention characteristics. BMC Public Health. 2023;23(1):2214.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Veazie S, Gilbert J, Winchell K, et al. Addressing social isolation to improve the health of older adults: a rapid review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2019 Feb. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537909/

  40. Creswell JD, Irwin MR, Burklund LJ, Lieberman MD, Arevalo JM, Ma J, et al. Mindfulness-Based Stress Reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain Behav Immun. 2012;26(7):1095–101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Fong SS, Wong JY, Chung LM, Yam TT, Chung JW, Lee YM, et al. Changes in heart-rate variability of survivors of nasopharyngeal cancer during Tai Chi Qigong practice. J Phys Ther Sci. 2015;27(5):1577–9.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lindsay EK, Marsland AL, Cole SW, Dutcher JM, Greco CM, Wright AGC, et al. Mindfulness-Based Stress Reduction reduces pro-inflammatory gene regulation but not systemic inflammation among older adults: a randomized controlled trial. Psychosom Med. 2023 Nov 17. https://doi.org/10.1097/PSY.0000000000001264. Online ahead of print.

  43. Lindsay EK, Creswell JD, Stern HJ, Greco CM, Walko TD, Dutcher JM, et al. Mindfulness-based stress reduction increases stimulated IL-6 production among lonely older adults: A randomized controlled trial. Brain Behav Immun. 2022;104:6–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Gronewold J, Engels M, Svd Velde, Cudjoe TKM, Duman E-E, Jokisch M, et al. Effects of life events and social isolation on stroke and coronary heart disease. Stroke. 2021;52(2):735–47.

    Article  CAS  PubMed  Google Scholar 

  45. Feeney J, Dooley C, Finucane C, Kenny RA. Stressful life events and orthostatic blood pressure recovery in older adults. Health Psychol. 2015;34(7):765–74.

    Article  PubMed  Google Scholar 

  46. Grönlund A. More control, less conflict? job demand-control, gender and work-family conflict. Gend Work Organ. 2007;14(5):476–97.

    Article  Google Scholar 

  47. Davis MC, Matthews KA, Twamley EW. Is life more difficult on Mars or Venus? A meta-analytic review of sex differences in major and minor life events. Ann Behav Med. 1999;21(1):83–97.

    Article  CAS  PubMed  Google Scholar 

  48. Aneshensel CS, Pearlin LI. Structural contexts of sex differences in stress. Gender and stress. New York, NY, US: Free Press; 1987. p. 75–95.

    Google Scholar 

  49. Sternthal MJ, Slopen N, Williams DR. Racial disparities in health: how much does stress really matter? Du Bois Rev. 2011;8(1):95–113.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Mario S, Ana VD-R, Samson YG, Allison B, Patricia D, Sharon W, et al. Perceived discrimination is associated with health behaviours among African-Americans in the Jackson Heart Study. J Epidemiol Community Health. 2016;70(2):187.

    Article  Google Scholar 

  51. • Ransome Y, Valido AD, Espelage DL, Clements GL, Harrell C, Eckel C, et al. A systematic review of how social connectedness influences associations between racism and discrimination on health outcomes. Epidemiol Rev. 2023;45(1):44–62. https://doi.org/10.1093/epirev/mxad009. PMID: 37477041; PMCID: PMC10748800. This publication describes the social connectedness and association between racism.

    Article  PubMed  Google Scholar 

  52. Gardiner C, Geldenhuys G, Gott M. Interventions to reduce social isolation and loneliness among older people: an integrative review. Health Soc Care Community. 2018;26(2):147–57.

    Article  PubMed  Google Scholar 

  53. • Rajai N, Medina-Inojosa JR, Lewis BR, Sheffeh MA, Baez-Suarez A, Nyman M, et al. Association between social isolation with age-gap determined by artificial intelligence-enabled electrocardiography. JACC Adv. 0(0). https://doi.org/10.1016/j.jacadv.2024.100890. The manuscript highlights the novel role of artificial intelligence-enabled electrocardiography in evaluating the impact of social isolation on aging.

  54. • Child ST, Albert MA. Social networks and health outcomes: importance for racial and socioeconomic disparities in cardiovascular outcomes. Curr Cardiovasc Risk Rep. 2018;12(12):30. PMID: 36248194; PMCID: PMC9559779. This manuscript describes the social networks and racial disparities.

    Article  PubMed  PubMed Central  Google Scholar 

  55. • Mukherjee D. Racial disparity and percutaneous coronary intervention outcomes. Am J Cardiol. 2023;206:347–8. https://doi.org/10.1016/j.amjcard.2023.08.144. Epub 2023 Sep 12. PMID: 37704466. This paper highlights the steps to tackle health care disparities by improving quality and safety.

    Article  PubMed  Google Scholar 

  56. Office of the Surgeon G. Publications and reports of the surgeon general. Our epidemic of loneliness and isolation: the US Surgeon General’s Advisory on the healing effects of social connection and community. Washington (DC): US Department of Health and Human Services; 2023. Pubmed ID 37792968.

  57. Lim MH, Qualter P, Ding D, Holt-Lunstad J, Mikton C, Smith BJ. Advancing loneliness and social isolation as global health challenges: taking three priority actions. Public Health Res Pract. 2023;33(3):3332320. https://doi.org/10.17061/phrp3332320.

  58. Holt-Lunstad J. National health guidelines for social connection: what is the evidence in support and what might the guidelines say? Policy Insights Behav Brain Sci. 2023;10(1):41–50.

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Nazareth Hospital, Trinity Health Mid-Atlantic, Philadelphia, PA, USA

    Syed Mohammed Usama

  2. Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

    Yash Lalit Kothari

  3. M. S. Ramaiah Medical College, Bengaluru, Karnataka, India

    Aditya Karthikeyan

  4. Department of Critical Care Medicine, Mayo Clinic Health System - Southwest Minnesota Region, Mankato, MN, USA

    Syed Anjum Khan

  5. Division of Interventional Cardiology, Department of Cardiovascular Medicine, 200 1st St SW, Rochester, MN, 55905, USA

    Mohammad Sarraf & Vinayak Nagaraja

Authors
  1. Syed Mohammed Usama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yash Lalit Kothari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aditya Karthikeyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Syed Anjum Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohammad Sarraf
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vinayak Nagaraja
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SMU, YLK wrote the first draft. All authors reviewed the manuscript.

Corresponding author

Correspondence to Vinayak Nagaraja.

Ethics declarations

Conflicts of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclosures

No relationships with industry.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Usama, S.M., Kothari, Y.L., Karthikeyan, A. et al. Social Isolation, Loneliness, and Cardiovascular Mortality: The Role of Health Care System Interventions. Curr Cardiol Rep (2024). https://doi.org/10.1007/s11886-024-02066-x

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11886-024-02066-x

Keywords

Search

Navigation