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Social Networks and Incident Stroke Among Women With Suspected Myocardial Ischemia

From the Department of Psychiatry, VA San Diego Healthcare System (T.R.), San Diego, California; Department of Psychiatry, (T.R.), University of California, San Diego, California; Department of Psychology, (S.E.L.), San Diego State University/University of California, San Diego, San Diego, California; Department of Epidemiology, Joint Doctoral Program in Clinical Psychology (M.B.O., B.D.J., C.M., S.F.K., S.E.R.), University of Pittsburgh, Pennsylvania; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (J.F., D.S.K.), Bethesda, MD; Department of Medicine, (V.B.), University of Alabama at Birmingham, Birmingham, Alabama; Department of Medicine, (K.Y., D.S.S.), University of Florida, Gainesville, Florida; Department of Medicine, (D.S.S.), North Florida/South Georgia VA Healthcare System, Gainesville, Florida; Department of Medicine, (C.E.C., L.J.S.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Medicine, (V.V., S.P.), Emory University, Atlanta, Georgia; and Department of Medicine, (C.N.B.M.), Cedars-Sinai Medical Center, Los Angeles, California.

Address correspondence and reprint requests to Thomas Rutledge, Psychology Service 116B, VA San Diego Healthcare System, Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail: Thomas.Rutledge{at}va.gov

Objective: To describe the prospective relationship between social networks and nonfatal stroke events in a sample of women with suspected myocardial ischemia. Social networks are an independent predictor of all-cause and cardiovascular mortality, but their relationship with stroke events in at-risk populations is largely unknown.

Method: A total of 629 women (mean age = 59.6 ± 11.6 years) were evaluated at baseline for cardiovascular disease risk factors as part of a protocol including coronary angiography; the subjects were followed over a median 5.9 years to track the incidence of cardiovascular events including stroke. Participants also completed the Social Network Index (SNI), measuring the presence/absence of 12 types of common social relationships.

Results: Stroke events occurred among 5.1% of the sample over follow-up. More isolated women were older and less educated, with higher rates of smoking and hypertension, and increased use of cardiovascular medications. Women with smaller social networks were also more likely to show elevations (scores of 10) on the Beck Depression Inventory (54% versus 41%, respectively; p = .003). Relative to women with higher SNI scores, Cox regression results indicated that more isolated women experienced strokes at greater than twice the rate of those with more social relationships after adjusting for covariates (hazard ratio = 2.7; 95% Confidence Interval = 1.1–6.7).

Conclusions: Smaller social networks are a robust predictor of stroke in at-risk women, and the magnitude of the association rivals that of conventional risk factors.

Key Words: social networks • coronary artery disease • women • prospective • stroke

Abbreviations: CAD = coronary artery disease; SES = socioeconomic status; CVD = cardiovascular disease; WISE = Women's Ischemia Syndrome Evaluation; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft; SNI = Social Network Index; BDI = Beck Depression Inventory; HR = hazard ratio.