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Women, Loneliness, and Incident Coronary Heart Disease

From the Department of Psychiatry (R.C.T.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Epidemiology (R.C.T.), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; and the Department of Society, Human Development, and Health (L.D.K.), Harvard School of Public Health, Boston, Massachusetts.

Address correspondence and reprint requests to Rebecca C. Thurston, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA 15213. E-mail: thurstonrc{at}upmc.edu

Objective: To examine associations between loneliness and risk of incident coronary heart disease (CHD) over a 19-year follow-up period in a community sample of men and women. Loneliness, the perceived discrepancy between actual and desired social relationships, has been linked to several adverse health outcomes. However, no previous research has prospectively examined the association between loneliness and incident CHD in a community sample of men and women.

Methods: Hypotheses were examined using data from the First National Health and Nutrition Survey and its follow-up studies (n = 3003). Loneliness, assessed by one item from the Center for Epidemiologic Studies of Depression scale, and covariates were derived from baseline interviews. Incident CHD was derived from hospital records/death certificates over 19 years of follow-up. Hypotheses were evaluated, using Cox proportional hazards models.

Results: Among women, high loneliness was associated with increased risk of incident CHD (high: hazard ratio = 1.76, 95% Confidence Interval = 1.17–2.63; medium: hazard ratio = 0.98, 95% Confidence Interval = 0.64–1.49; reference: low), controlling for age, race, education, income, marital status, hypertension, diabetes, cholesterol, physical activity, smoking, alcohol use, systolic and diastolic blood pressures, and body mass index. Findings persisted additionally controlling for depressive symptoms. No significant associations were observed among men.

Conclusions: Loneliness was prospectively associated with increased risk of incident CHD, controlling for multiple confounding factors. Loneliness among women may merit clinical attention, not only due to its impact on quality of life but also its potential implications for cardiovascular health.

Key Words: coronary heart disease • cardiovascular disease • gender • women • loneliness • depression

Abbreviations: CHD = coronary heart disease; SBP = systolic blood pressure; NHANES I = First National Health and Nutrition Examination Survey; CESD = Center for Epidemiologic Studies of Depression; BMI = body mass index; ICD-9 = International Classification of Diseases, Ninth Revision.