Social isolation, vital exhaustion, and incident heart failure: findings from the Atherosclerosis Risk in Communities Study
Social isolation, vital exhaustion, and incident heart failure: findings from the Atherosclerosis Risk in Communities Study
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DOI：
10.1093/eurjhf/hfs064
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发表时间：
2012-07-01
影响因子：
18.2
通讯作者：
Corbie-Smith, Giselle
中科院分区：
文献类型：
--
作者：
Cene, Crystal W.;Loehr, Laura;Corbie-Smith, Giselle
前瞻性研究表明，社会隔离（即缺乏社会接触）可预测冠心病（CHD）事件，但尚不清楚它是否可预测心力衰竭（HF）事件以及哪些因素可能介导这种关联。HF患者可能更容易受到社会孤立，因为他们往往年龄较大，并且可能由于生命过程因素（例如退休或丧亲）而破坏了社会关系。我们前瞻性地研究了社会隔离程度高的个体是否比社会隔离程度低的个体有更高的HF发病率，并确定了这种关联是否是由生命衰竭介导的。（1990 - 1992）在使用考克斯比例风险模型的社区动脉粥样硬化风险（ARIC）研究中，种族/研究社区、性别、当前吸烟、饮酒和合并症。我们进行了调解分析，根据男爵和肯尼的方法。在中位随访16.9人-年后，发生了1727（13.0）起HF事件。高社交隔离风险组与低社交隔离风险组相比，HF事件的校正风险更大（风险比1.21，95置信区间1.081.35）。我们的数据表明，生命衰竭强烈介导了较高的社会隔离和事件HF之间的关联（调整生命衰竭后，较高与较低社会隔离组的β系数变化百分比为36）。这些数据表明，较高的社会隔离是事件HF的独立危险因素，这种关联似乎强烈介导了生命衰竭。
Prospective studies have shown that social isolation (i.e. lack of social contacts) predicts incident coronary heart disease (CHD), but it is unclear whether it predicts incident heart failure (HF) and what factors might mediate this association. HF patients may be more susceptible to social isolation as they tend to be older and may have disrupted social relationships due to life course factors (e.g. retirement or bereavement). We prospectively examined whether individuals with higher vs. low social isolation have a higher incidence of HF and determined whether this association is mediated by vital exhaustion.We estimated incident HF hospitalization or death among 14 348 participants from Visit 2 (19901992) in the Atherosclerosis Risk in Communities (ARIC) study using Cox proportional hazard models which were sequentially adjusted for age, race/study community, gender, current smoking, alcohol use, and co-morbidities. We conducted mediation analyses according to the Baron and Kenny method. After a median follow-up of 16.9 person-years, 1727 (13.0) incident HF events occurred. The adjusted hazard of incident HF was greater for those in the higher vs. low social isolation risk group (hazard ratio 1.21, 95 confidence interval 1.081.35). Our data suggest that vital exhaustion strongly mediates the association between higher social isolation and incident HF (the percentage change in beta coefficient for higher vs. low social isolation groups after adjusting for vital exhaustion was 36).These data suggest that greater social isolation is an independent risk factor for incident HF, and this association appears to be strongly mediated by vital exhaustion.