The Link between Loneliness, Social Isolation, and Cardiovascular Disease

Introduction: Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Loneliness, a subjective feeling of social isolation, and social isolation, an objective lack of social connections, contribute to social vulnerability and physical frailty. Psychological factors and social support play important roles in CVD, affecting health behaviors and physiological mechanisms. This review aims to provide an understanding of how loneliness and social isolation impact CVD. Methods: A literature review was conducted to identify relevant studies investigating the association between loneliness, social isolation, and cardiovascular disease. Results: The findings indicate that social isolation and loneliness are significant risk factors for CVD, independent of other risk factors. The prevalence of loneliness has increased in modern society, affecting individuals of all ages. Loneliness and social isolation influence physiological processes such as activating the HPA axis, causing inflammation and alterations in immune function, and activating the sympathetic nervous system. These effects contribute to an increased risk of CVD, including elevated blood pressure, hypertension, atherosclerosis, and potential cardiac autonomic dysregulation. Conclusion: Loneliness and social isolation pose significant risks for cardiovascular disease (CVD), influencing physiological processes such as inflammation, immune function, and sympathetic nervous system activation. Understanding these relationships is crucial for developing effective strategies to prevent and manage CVD, emphasizing the importance of interventions targeting both psychological and physiological aspects of social well-being.

Keywords: Loneliness, Social Isolation, Cardiovascular Disease

INTRODUCTION

Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality worldwide. The impact of CVD is significant in terms of economic burden. Understanding and identifying risk factors can enhance preventive strategies. In 2016, a systematic review indicated that participants with poor social conditions had a 30% higher risk of heart attack and stroke[1].

As social beings, humans rely on a safe and secure social environment for survival and development. The perception of social isolation, or loneliness, increases vigilance to threats and amplifies feelings of vulnerability while also intensifying the desire for social connection[2].

Loneliness is defined as the discrepancy between desired and actual social relationships of an individual[3]. Loneliness occurs when one feels alone or lacks desired relationships with others[4].

Social isolation is defined as the infrequency of direct contact with people for social relationships, such as family, friends, or members of the same community or religious group[4]. It can be an objective measure of the lack of social connection or interaction[3].

Loneliness can be an emotional response to social isolation[3]. Social isolation and feelings of loneliness are related but not identical[4]. Although it is generally believed that social isolation causes loneliness, loneliness can be experienced within marriage, family, friendships, or larger social groups. Conversely, an individual can feel socially satisfied while being alone, and loneliness is considered more related to the quality of relationships rather than quantity [2,3]. Thus, loneliness is a subjective negative concept concerning feelings of isolation [1,2].

Loneliness and isolation place individuals at risk of social vulnerability or weakness. This dynamic vulnerability concept is closely associated with sustainability, development, social exclusion, poverty, and lack of social support. Additionally, social vulnerability is closely linked to physical frailty and mortality[5].

Psychological conditions are linked to heart diseases in various ways, decreased cardiac output from various causes, such as congestive heart failure, arrhythmia, pulmonary embolus, and myocardial infarction; acute myocardial infarction presents with confusion as the major symptom in 13% of elderly patients; aged patients do not complain of typical pain; often they complain of indigestion; vital signs may be abnormal, and patient may look ill (ashen coloring, weak, nauseated, sweaty) and be confused[6].

Social support may influence CVD events and death by affecting health-related behaviors such as smoking, diet, physical activity, help-seeking during or after a cardiac event, and adherence to cardiac medication, or through its effects on physiologic mechanisms, such as alterations in cardiovascular, neuroendocrine, and immune function, that have been linked to increased CVD risk[7].

REVIEW

Epidemiology

Recently, there has been an increasing number of individuals at risk of loneliness in modern society due to social factors and demographic changes[3]. About 80% of individuals under the age of 18 experience loneliness, while 40% of adults experience loneliness[2].

The increase in life expectancy has tripled the number of people aged 60 and above since 1950. Older age is associated with reduced social interaction, longer periods of living alone, and a higher prevalence of loneliness. However, loneliness is more than just a result of age-related losses; it can be experienced at all stages of life[3]. Approximately 15-30% of the general population experience chronic loneliness[2].

The prevalence of loneliness has also increased with delayed marriage, more households where both parents work, and an increase in single-family dwellings. Additionally, the internet has completely transformed the way people live and interact. Despite increased digital connectivity, more people are experiencing social isolation. Recent research suggests that social media, instead of enhancing well-being, can actually harm it. The prevalence of loneliness in modern society is high enough to justify the need for interventions[3].

Social isolation and loneliness are chronic sources of stress that often occur in adults[3]. During the COVID-19 crisis, minimizing loneliness is crucial, as well as reducing stress, anxiety, and fear, to lower the risk of suicidal ideation. Social isolation, anxiety, fear of COVID-19 transmission, uncertainty, chronic stress, and economic difficulties can lead to the development or exacerbation of depression, anxiety, substance use, and other mental disorders in vulnerable populations, including individuals with pre-existing mental disorders and those living in areas with high COVID-19 prevalence[8].

Chronic social isolation has been shown to increase the risk of morbidity and mortality[2],[3], similar to other risk factors such as high blood pressure[2],[3], smoking, and obesity[3]. A meta-analysis involving 148 studies and 308,849 individuals followed for an average of 7.5 years showed that this effect of social isolation is independent of other risk factors. Strong social relationships can increase the likelihood of survival by 50%[9]. Loneliness has serious consequences for cognition, emotions, behavior, and health[2]. Loneliness and social isolation correlate to increased mortality rates. The overall likelihood of death due to loneliness and social isolation is 1.50, comparable to light smoking and greater than the risks associated with obesity and hypertension. A recent meta-analysis showed that social isolation, loneliness, and living alone increase the likelihood of death by 29%, 26%, and 32%, respectively[10].

Individuals with poor social health (socially isolated, lacking support, and lonely) are 42% more likely to develop CVD and twice as likely to die from CVD within a five-year period among adults living in the community,

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