Cene, Crystal W, Leng, Xiaoyan I, Allison, Matthew A, Breathett, Khadijah, Bird, Chloe, Coday, Mace C, Corbie-Smith, Giselle, Foraker, Randi, Ijioma, Nkechinyere N, Rosal, Milagros C, Sealy-Jefferson, Shawnita, and Kroenke, Candyce H
Introduction:Social isolation, or lack of social network ties, independently predicts incident heart failure (HF) in middle-aged adults (mediated through depressive symptoms). However, it is unknown whether social isolation predicts HF in older adults and if so, what mediates and moderates the association. These questions are important given that the risks of HF and social isolation increase with age.Objectives:To 1) examine whether socially isolated Women?s Health Initiative (WHI) participants had higher HF incidence than those who were not; 2) explore whether depressive symptoms mediate the association; and 3) assess the impact of race/ethnicity, perceived social support, stressful life events, and caregiving as potential effect modifiers.Methods:The sample included 44,174 racially/ethnically diverse WHI participants (mean age at baseline: 63 years) who had adjudicated data on incident HF requiring hospitalization. Women were classified as socially isolated if they were not married and had no religious or community ties. Depressive symptoms were measured using the 8-item Burnham short version of the Center for Epidemiologic Studies- Depression scale. Perceived social support was measured using 9 items from the Medical Outcomes Study social support scale. We assessed 10 stressful life events using a modified questionnaire from the Beta-Blocker Heart Attack Trial. We used a single item to assess caregiving.Results:Over a median 15.0 years follow-up, 6% (n=2148) HF incidence was observed among 35,586 women, and 8% (n=2800) were socially isolated. In an unadjusted model, women who were socially isolated had a 33% higher risk of incident HF than those who were not isolated (HR 1.33; 95% CI 1.15-1.54). In models fully adjusted for demographic, clinical and behavioral variables, general health, and physical functioning, socially isolated women had a 19% higher risk of developing HF (HR 1.19, 95% CI 1.03-1.39). Depressive symptoms did not mediate the association, nor did it differ by race/ethnicity, perceived support, life stressors, or caregiving.Conclusions:Our findings suggest a modest association between self-reported social isolation and incident HF. Future studies should examine other mediators (e.g. loneliness) of this association.