Social isolation, C-reactive protein, and coronary heart disease mortality among community-dwelling adults

The Rochester Center for Mind-Body Research, Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Box PSYCH-BPSM, Rochester, NY 14642, United States.
Social Science [?] Medicine (Impact Factor: 2.89). 05/2011; 72(9):1482-8. DOI: 10.1016/j.socscimed.2011.03.016
Source: PubMed


Social isolation confers increased risk for coronary heart disease (CHD) events and mortality. In two recent studies, low levels of social integration among older adults were related to higher levels of C-reactive protein (CRP), a marker of inflammation, suggesting a possible biological link between social isolation and CHD. The current study examined relationships among social isolation, CRP, and 15-year CHD death in a community sample of US adults aged 40 years and older without a prior history of myocardial infarction. A nested case-cohort study was conducted from a parent cohort of community-dwelling adults from the southeastern New England region of the United States (N = 2321) who were interviewed in 1989 and 1990. CRP levels were measured from stored sera provided by the nested case-cohort (n = 370), which included all cases of CHD death observed through 2005 (n = 48), and a random sample of non-cases. We found that the most socially isolated individuals had two-and-a-half times the odds of elevated CRP levels compared to the most socially integrated. In separate logistic regression models, both social isolation and CRP predicted later CHD death. The most socially isolated continued to have more than twice the odds of CHD death compared to the most socially integrated in a model adjusting for CRP and more traditional CHD risk factors. The current findings support social isolation as an independent risk factor of both high levels of CRP and CHD death in middle-aged adults without a prior history of myocardial infarction. Prospective study of inflammatory pathways related to social isolation and mortality are needed to fully delineate whether and how CRP or other inflammatory markers contribute to mechanisms linking social isolation to CVD health.

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    • "Affective disorders Depression CRP, IL-6 (after additional stress exposure) Rice et al. (2009), Fagundes et al. (2013) Anxiety disorders CRP, IL-6, TNFa, Duivis et al. (2013) Post Traumatic Stress Disorder CRP, TNFa, IL-4 Plantinga et al. (2013), Spitzer et al. (2010), Von Känel et al. (2007), Turner et al. (2013) Low socioeconomic status CRP, IL-6 (after additional stress exposure), sICAM, ET-1 Nazmi and Victora (2007), Brydon et al. (2004), Hong et al. (2006) Caregiver stress IL-6, CRP, D-dimer Nazmi and Victora (2007), Kiecolt-Glaser et al. (2003), Von Känel et al. (2006), Miller et al. (2008) Loneliness/social isolation IL-6, CRP, sICAM-1 Ford et al. (2006), Loucks et al. (2006), Heffner et al. (2011) Early life stress/childhood maltreatment CRP, fibrinogen Danese et al. (2007), Rooks et al. (2012) Acute stressors Population-wide Natural disasters CRP Yamauchi et al. (2013) Sporting events ET-1, sCD40L, sVCAM, MCP-1, TNFa, Wilbert-Lampen et al. (2010) Individual Bereavement IL-6, IL-1RA, sE-selectin Schultze-Florey et al. (2012), Cohen et al. (2015) Anger outburst CPR, IL-6 Suarez (2004), Coccaro et al. (2014) Acute laboratory stressors IL-1b, TNFa, IL-2, IL-4, IL-10, CRP Slavish et al. (2015) Table 2a Rodent models of chronic single stress-induced atherosclerosis development and progression. "
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    ABSTRACT: Cardiovascular disease (CVD) remains a leading cause of death worldwide and identification and therapeutic modulation of all its risk factors is necessary to ensure a lower burden on the patient and on society. The physiological response to acute and chronic stress exposure has long been recognized as a potent modulator of immune, endocrine and metabolic pathways, however its direct implications for cardiovascular disease development, progression and as a therapeutic target are not completely understood. More and more attention is given to the bidirectional interaction between psychological and physical health in relation to cardiovascular disease. With atherosclerosis being a chronic disease starting already at an early age the contribution of adverse early life events in affecting adult health risk behavior, health status and disease development is receiving increased attention. In addition, experimental research into the biological pathways involved in stress-induced cardiovascular complications show important roles for metabolic and immunologic maladaptation, resulting in increased disease development and progression. Here we provide a concise overview of human and experimental animal data linking chronic and acute stress to CVD risk and increased progression of the underlying disease atherosclerosis. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Aug 2015 · Brain Behavior and Immunity
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    • "People who are socially isolated have increased risk of all-cause mortality (Cacioppo and Hawkley, 2003; Seeman, 1996), and several infectious , neoplastic, and cardiovascular diseases (Caspi et al., 2006; Cohen et al., 1997; Cole et al., 2003; Kroenke et al., 2006). A possible biological mechanism of these effects is systemic inflammation, as social isolation has been shown to predict heightened systemic inflammation as assessed by circulating levels of inflammatory markers (Heffner et al., 2011). Furthermore, it is thought that social isolation is associated with sleep disturbance through a disruption of social zeitgebers (i.e., social cues that maintain the sleep–wake activity schedule), which are increasingly viewed as being critical in the homeostatic regulation of sleep–wake activity (Mistlberger and Skene, 2004). "
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    ABSTRACT: Both sleep disturbance and social isolation increase the risk for morbidity and mortality. Systemic inflammation is suspected as a potential mechanism of these associations. However, the complex relationships between sleep disturbance, social isolation, and inflammation have not been examined in a population-based longitudinal study. This study examined the longitudinal association between sleep disturbance and systemic inflammation, and the moderating effects of social isolation on this association. The CARDIA study is a population-based longitudinal study conducted in four US cities. Sleep disturbance - i.e., insomnia complaints and short sleep duration - was assessed in 2962 African-American and white adults at baseline (2000-2001, ages 33-45 years). Circulating C-reactive protein (CRP) was measured at baseline and follow-up (2005-2006). Interleukin-6 (IL-6) and subjective and objective social isolation (i.e., feelings of social isolation and social network size) were measured at follow-up. Sleep disturbance was a significant predictor of inflammation five years later after full adjustment for covariates (adjusted betas: 0.048, P=0.012 for CRP; 0.047, P=0.017 for IL-6). Further adjustment for baseline CRP revealed that sleep disturbance also impacted the longitudinal change in CRP levels over five years (adjusted beta: 0.044, P=0.013). Subjective social isolation was a significant moderator of this association between sleep disturbance and CRP (adjusted beta 0.131, P=0.002). Sleep disturbance was associated with heightened systemic inflammation in a general population over a five-year follow-up, and this association was significantly stronger in those who reported feelings of social isolation. Clinical interventions targeting sleep disturbances may be a potential avenue for reducing inflammation, particularly in individuals who feel socially isolated. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Feb 2015 · Brain Behavior and Immunity
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    • "Active engagement with life consists of interpersonal relationships and social contacts as well as productive activity, which creates a sense of societal value (Rowe and Kahn, 1997). Social isolation occurs when an individual has few social contacts or relationships and few connections or ties within the community, and social isolation has been found to be a risk factor for health and mortality (Berkman et al., 2000; House, 2001; Strike and Steptoe, 2004; Heffner et al., 2011). Alternatively, remaining active and maintaining a social network has been linked to longevity and to positive health-related effects (Cohen, 2004; Uchino, 2004; Cohen and Janicki- Deverts, 2009). "
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    ABSTRACT: Community-based preventative programmes are increasing in demand as the UK seeks alternative ways of supporting the growing number of older adults. As the use and promotion of preventative programmes increase, so does the need for evidence supporting their effectiveness. Through the use of mixed methods, this study explored a singing community-arts programme, the Golden Oldies, to determine the extent to which the programme contributes to participants' (n = 120) sense of health, self-development and social connectedness. Quantitative analyses found that between 73.1 and 98.3 per cent of participants agreed or strongly agreed that the Golden Oldies contributed to their self-development, health and sense of community as well as revealing a statistically significant increase in self-reported health prior to participation in the programme to the time of the study. Qualitative analysis (n = 5) revealed three themes—the Golden Oldies as: (i) a reduction in social isolation and increase in social contact; (ii) a therapeutic source; and (iii) a new lease for life. The results provide evidence of the preventative nature of the Golden Oldies programme through self-reported improvements in health and social relationships where social connections appeared to be the important thread that contributed to the perceived benefits. Implications for policy, practice and research are discussed.
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