Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women
Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women
复制标题
DOI：
10.1136/heartjnl-2017-312663
复制
发表时间：
2018-09-01
期刊：
影响因子：
5.7
通讯作者：
Elovainio, Marko
中科院分区：
文献类型：
--
作者：
Hakulinen, Christian;Pulkki-Raback, Laura;Elovainio, Marko
目的探讨社会隔离和孤独是否（1）预测无急性心肌梗死（AMI）或卒中病史者的急性心肌梗死（AMI）和卒中，（2）与有AMI或卒中病史者的死亡风险相关，和（3）这些关联在多大程度上是由已知的风险因素或预先-现有的慢性疾病。方法参与者是来自英国生物库的479054人。暴露是自我报告的社会孤立和孤独。结果7.1年内首次发生AMI 5731例，首次发生脑卒中3471例。在调整人口统计学的模型中，社会隔离与AMI（HR 1.43，95% CI 1.3至-1.55）和卒中（HR 1.39，95% CI 1.25至1.54）的风险较高相关。校正所有其他风险因素后，AMI的HR降低84%至1.07（95% CI 0.99至1.16），卒中的HR降低83%至1.06（95% CI 0.96至1.19）。在此之前，孤独症与较高的AMI风险相关（HR 1.49，95% CI 1.36至1.64），但经过调整后显著减弱（HR 1.06，95% CI 0.96至1.17）。卒中也是如此（校正前HR 1.36，95% CI 1.20 - 1.55，校正后HR 1.04，95% CI 0.91 - 1.19）。在有AMI病史的参与者中，社交孤立（而非孤独）与死亡率增加相关（HR 1.25，95% CI 1.03 - 1.51）或卒中（HR 1.32，95%CI 1.08 ~ 1.61）结论孤立和孤独的人发生AMI和卒中的危险性增加，在有AMI或卒中史的人中，增加死亡风险。大多数这种风险可以用传统的风险因素来解释。
Objective To examine whether social isolation and loneliness (1) predict acute myocardial infarction (AMI) and stroke among those with no history of AMI or stroke, (2) are related to mortality risk among those with a history of AMI or stroke, and (3) the extent to which these associations are explained by known risk factors or pre-existing chronic conditions.Methods Participants were 479 054 individuals from the UK Biobank. The exposures were self-reported social isolation and loneliness. AMI, stroke and mortality were the outcomes.Results Over 7.1 years, 5731 had first AMI, and 3471 had first stroke. In model adjusted for demographics, social isolation was associated with higher risk of AMI (HR 1.43, 95% CI 1.3 to -1.55) and stroke (HR 1.39, 95% CI 1.25 to 1.54). When adjusted for all the other risk factors, the HR for AMI was attenuated by 84% to 1.07 (95% CI 0.99 to 1.16) and the HR for stroke was attenuated by 83% to 1.06 (95% CI 0.96 to 1.19). Loneliness was associated with higher risk of AMI before (HR 1.49, 95% CI 1.36 to 1.64) but attenuated considerably with adjustments (HR 1.06, 95% CI 0.96 to 1.17). This was also the case for stroke (HR 1.36, 95% CI 1.20 to 1.55 before and HR 1.04, 95% CI 0.91 to 1.19 after adjustments). Social isolation, but not loneliness, was associated with increased mortality in participants with a history of AMI (HR 1.25, 95% CI 1.03 to 1.51) or stroke (HR 1.32, 95% CI 1.08 to 1.61) in the fully adjusted model.Conclusions Isolated and lonely persons are at increased risk of AMI and stroke, and, among those with a history of AMI or stroke, increased risk of death. Most of this risk was explained by conventional risk factors.