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Braig S, Denkinger MD, Dallmeier D, Klenk J, Rothenbacher D. Social isolation, loneliness and the relationship with serum biomarkers, functional parameters and mortality in older adults. Aging Clin Exp Res 2025; 37:140. [PMID: 40317389 PMCID: PMC12049398 DOI: 10.1007/s40520-025-03041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Accepted: 04/10/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Pathways between social isolation (SI), loneliness and health are unclear. AIMS To analyze the relationship between SI and loneliness with biomarkers of inflammation, cardiac and immune function, functional parameters, and mortality. METHODS SI (Lubben Social Network Scale) from family, friends, and overall as well as loneliness (single direct question) were assessed at baseline in a population-based cohort study of 1459 community-dwelling adults aged 65 + in Germany. Serum biomarkers and functional parameters measured at baseline and at three-year follow-up included high-sensitivity C reactive protein (hs-CRP), growth differentiation factor-15 (GDF-15), N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hs-cTnI), high-sensitivity troponin T (hs-cTnT), gait speed, and hand grip strength. We used linear and Cox regression analyses adjusted for age and sex (model 1) and established confounders (model 2). RESULTS High SI from friends was associated with small but significant adverse associations with some biomarkers (hs-CRP, GDF-15, hs-cTnT) at follow-up (model 1). High SI from family associated with NT-proBNP (model 2), high SI and moderate to severe loneliness with lower gait speed. Loneliness was linked to hs-CRP at baseline, but SI was a stronger predictor of biomarker levels. High SI overall (Hazard ratio 1.39, 95% CI 1.15; 1.67, model 2) was associated with increased 10-year mortality. DISCUSSION Mainly SI from friends is linked to unfavorable biomarker profiles with small associations. Overall SI was negatively associated with functional parameters and positively with mortality. CONCLUSIONS Further research should confirm our findings using, e.g. a multidimensional assessment of loneliness.
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Affiliation(s)
- Stefanie Braig
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany.
| | - Michael D Denkinger
- Research Unit on Ageing, Geriatric Center Ulm/Alb-Donau, AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
- Institute for Geriatric Research, Ulm University Medical Center, Ulm, Germany
| | - Dhayana Dallmeier
- Research Unit on Ageing, Geriatric Center Ulm/Alb-Donau, AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
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Sharif-Nia H, Jackson AC, Salehi S, Miraghai F, Hosseini SH. Loneliness and repetitive negative thinking mediate the link between social health and cardiac distress in heart disease patients. Sci Rep 2025; 15:11804. [PMID: 40189696 PMCID: PMC11973143 DOI: 10.1038/s41598-025-96968-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Accepted: 04/01/2025] [Indexed: 04/09/2025] Open
Abstract
Cardiovascular diseases are the leading cause of mortality worldwide, contributing to one-third of global deaths. Beyond physical health, heart disease is associated with cardiac distress, an emotional response that can negatively impact recovery and well-being. Understanding the psychological and social mechanisms underlying cardiac distress is crucial for improving patient outcomes. This study examines how social health (social support and social isolation) influences cardiac distress, with loneliness and repetitive negative thinking as mediators. To evaluate a theoretical model linking social health to cardiac distress, mediated by loneliness and repetitive negative thinking in patients with heart disease. A cross-sectional, correlational study was conducted in 2024 with 400 cardiac patients from two hospitals and one private clinic in Amol, Iran. Participants completed validated questionnaires assessing cardiac distress, social support, social isolation, loneliness, and repetitive negative thinking. Structural equation modeling was used for data analysis. Social isolation (r = 0.47, p < 0.001) and repetitive negative thinking (r = 0.50, p < 0.001) were significantly associated with greater cardiac distress. Social support negatively predicted both loneliness (β = - 0.32, p < 0.001) and cardiac distress (β = - 0.25, p < 0.01). Indirect effects showed that social support reduced cardiac distress by decreasing loneliness and repetitive negative thinking (β = - 0.23, p < 0.01), while social isolation increased cardiac distress through its influence on loneliness and repetitive negative thinking (β = 0.18, p = 0.05). The model explained 47.4% of the variance in cardiac distress. These findings highlight the importance of social health in managing cardiac distress among heart disease patients. Strengthening social support may alleviate loneliness and reduce repetitive negative thinking, ultimately improving emotional well-being and health outcomes. Future research should explore targeted interventions addressing these psychosocial factors to effectively reduce cardiac distress.
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Affiliation(s)
- Hamid Sharif-Nia
- Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alun C Jackson
- Centre on Behavioral Health, Hong Kong University, Pokfulam, Hong Kong, People's Republic of China
| | - Safoura Salehi
- Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fateme Miraghai
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Seyed Hamzeh Hosseini
- Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Benito T, Zaharia G, Pérez A, Jaramillo C, Lorenzo M, Mollar A, Martínez C, Bejarano E, Cebrián F, Civera J, Núñez J. Risk factors and prognostic impact of unwanted loneliness in heart failure. Sci Rep 2024; 14:22229. [PMID: 39333672 PMCID: PMC11436651 DOI: 10.1038/s41598-024-72847-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 09/11/2024] [Indexed: 09/29/2024] Open
Abstract
Heart failure (HF) is associated with a high prevalence of unwanted loneliness. This study aimed to assess whether unwanted loneliness was associated with adverse clinical endpoints in HF patients. Additionally, we also aimed to examine the risk factors associated with unwanted loneliness in HF. We included 298 patients diagnosed with stable HF. Clinical, biochemical, echocardiographic parameters and loneliness using ESTE II scale were assessed. We analyzed the association between the exposure and adverse clinical endpoints by Cox (death or any hospitalization), and negative binomial regressions (recurrent hospitalizations or visits to the emergency room). Risk factors associated with loneliness were analyzed using logistic regression. The mean age was 75.8 ± 9.4 years, with 111 (37.2%) being women, 53 (17.8%) widowed, and 154 (51.7%) patients having preserved ejection fraction. The median (p25-p75%) ESTE II score was 9.0 (6.0-12.0), and 36.9% fulfilled the loneliness criteria (> 10). Both women (OR = 2.09; 95% CI 1.11-3.98, p = 0.023) and widowhood (OR = 3.25; 95% CI 1.51-7.01, p = 0.003) were associated with a higher risk of loneliness. During a median follow-up of follow-up of 362 days (323-384), 93 patients (31.3%) presented the combined episode of death or all-cause admissions. Loneliness was significantly related to the risk of time to the composite of death or any readmission during the composite (HR = 1.83; 95% CI 1.18-2.84, p = 0.007). Women and widowhood emerge as risk factors for unwanted loneliness in HF patients. Unwanted loneliness is associated with higher morbidity during follow-up.
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Affiliation(s)
- Teresa Benito
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Georgiana Zaharia
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Adora Pérez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Cristina Jaramillo
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Miguel Lorenzo
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Anna Mollar
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Carolina Martínez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Evelin Bejarano
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Francisco Cebrián
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Jose Civera
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Julio Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain.
- CIBER Cardiovascular, Madrid, Spain.
- Departament of Medicine, University of Valencia, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain.
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Bernardi E, Visioli F. Fostering wellbeing and healthy lifestyles through conviviality and commensality: Underappreciated benefits of the Mediterranean Diet. Nutr Res 2024; 126:46-57. [PMID: 38613923 DOI: 10.1016/j.nutres.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/15/2024]
Abstract
Among the often-neglected features of healthy diets, such as the Mediterranean diet, is the preparation and sharing of food, which is (or was) done in a social environment governed by social rules rather than by time constraints. The act of eating is a daily human practice that is not limited to meeting nutritional and energy needs but also involves a constructed social dimension of sharing meals that is part of the process of human civilization and food cultures around the world. In this narrative review, we outline the importance of conviviality in steering part of the health effects of healthful diets, with special reference to the Mediterranean diet. Based on the available evidence, we suggest that public health initiatives (such as nudging to promote conviviality) to improve people's eating and living styles, reduce loneliness, and promote the sharing of meals could improve health. Interventions aimed at directly increasing/improving people's social relationships, networking, and conviviality can-directly and indirectly-improve both psychological well-being and general health.
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Affiliation(s)
- Elisabetta Bernardi
- Department of Biosciences, Biotechnologies and Environment, University of Bari "Aldo Moro" - Bari, Italy
| | - Francesco Visioli
- Department of Molecular Medicine, University of Padova, Italy; IMDEA-Food, Madrid, Spain.
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Takabayashi K, Hamada T, Kubo T, Iwatsu K, Ikeda T, Okada Y, Kitamura T, Kitaguchi S, Kimura T, Kitaoka H, Nohara R. External Validation of the Japanese Clinical Score for Mortality Prediction in Patients With Acute Heart Failure. Circ J 2023; 87:543-550. [PMID: 36574994 DOI: 10.1253/circj.cj-22-0652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND To predict mortality in patients with acute heart failure (AHF), we created and validated an internal clinical risk score, the KICKOFF score, which takes physical and social aspects, in addition to clinical aspects, into account. In this study, we validated the prediction model externally in a different geographic area. METHODS AND RESULTS There were 2 prospective multicenter cohorts (1,117 patients in Osaka Prefecture [KICKOFF registry]; 737 patients in Kochi Prefecture [Kochi YOSACOI study]) that had complete datasets for calculation of the KICKOFF score, which was developed by machine learning incorporating physical and social factors. The outcome measure was all-cause death over a 2-year period. Patients were separated into 3 groups: low risk (scores 0-6), moderate risk (scores 7-11), and high risk (scores 12-19). Kaplan-Meier curves clearly showed the score's propensity to predict all-cause death, which rose independently in higher-risk groups (P<0.001) in both cohorts. After 2 years, the cumulative incidence of all-cause death was similar in the KICKOFF registry and Kochi YOSACOI study for the low-risk (4.4% vs. 5.3%, respectively), moderate-risk (25.3% vs. 22.3%, respectively), and high-risk (68.1% vs. 58.5%, respectively) groups. CONCLUSIONS The unique prediction score may be used in different geographic areas in Japan. The score may help doctors estimate the risk of AHF mortality, and provide information for decisions regarding heart failure treatment.
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Affiliation(s)
| | - Tomoyuki Hamada
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | - Tsutomu Ikeda
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | - Yohei Okada
- Department of Preventive Services, School of Public Health, Kyoto University
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | | | | | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Ryuji Nohara
- Department of Cardiology, Takanohara Central Hospital
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Glover L, Sutton J, O'Brien E, Sims M. Social Networks and Cardiovascular Disease Events in the Jackson Heart Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.10.23287131. [PMID: 36945564 PMCID: PMC10029077 DOI: 10.1101/2023.03.10.23287131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Background Cardiovascular disease (CVD) disproportionately affects African American adults. Greater social networks (SN), or social connectedness, may lower the risk of CVD events. Objective Determine the association of SN and incident CVD and test mediation by depressive symptoms, hypertension control and diabetes control. Methods We used the Social Network Index (SNI) at exam 1 (2000-2004) to develop a continuous standardized SN score and binary categories (high vs. low) among participants in the Jackson Heart Study (n=5252, mean age=54.8 years). Surveillance of coronary heart disease (CHD), stroke, and heart failure (HF) events occurred after exam 1 (2005 for HF) until 2016. Using Cox proportional hazards regression, we estimated the association of SN and CVD events by sex and tested the mediation of depressive symptoms, hypertension control and diabetes control. Models adjusted for age, education, health behaviors, and CVD co-morbidities. Results Among women, the SN score was associated with a lower risk of CHD and HF after full adjustment (HR 0.78, 95% CI 0.68, 0.89 and HR 0.78, 95% CI 0.63, 0.95, respectively), but the association with stroke attenuated after adjustment for co-morbidities (HR 95% CI 0.88 95% CI 0.67, 1.14). SN scores were also associated with CHD in men (HR 0.84, 95% CI 0.70, 0.99) after full adjustment. High vs. low SN was associated with CHD in men and women, but not after adjustment for co-morbidities. There was no evidence of mediation by depressive symptoms, diabetes control, and hypertension control. Conclusion Higher SN may lower the risk of CVD events, especially in women.
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Koudstaal S. Social isolation and susceptibility for developing heart failure: are we exchanging a global pandemic for a new crisis in the making? EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac004. [PMID: 35923597 PMCID: PMC9242025 DOI: 10.1093/ehjopen/oeac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/14/2022]
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