Joint association of loneliness and traditional risk factor control and incident cardiovascular disease in diabetes patients

Author:

Wang Xuan1,Ma Hao1,Li Xiang1,Heianza Yoriko1,Fonseca Vivian23,Qi Lu14ORCID

Affiliation:

1. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine , 1440 Canal Street, New Orleans, LA 70112 , USA

2. Section of Endocrinology and Metabolism, Tulane University School of Medicine , New Orleans, LA , USA

3. Southeast Louisiana Veterans Health Care System , New Orleans, LA , USA

4. Department of Nutrition, Harvard T.H. Chan School of Public Health , 677 Huntington Ave, Boston, MA 02115 , USA

Abstract

Abstract Aims To investigate the prospective associations of the loneliness and social isolation scales with cardiovascular disease (CVD) risk in diabetes patients and compare the relative importance of loneliness and social isolation with traditional risk factors. Also, the interactions of loneliness or isolation with the degree of risk factor control in relation to CVD risk were evaluated. Methods and results A total of 18 509 participants diagnosed with diabetes from the UK Biobank were included. A two-item scale and a three-item scale were used to assess loneliness and isolation levels, respectively. The degree of risk factor control was defined as numbers of glycated hemoglobin (HbA1c), blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), smoking, and kidney condition controlled within the target range. During a mean follow-up of 10.7 years, 3247 total CVD incidents were documented, including 2771 coronary heart disease and 701 strokes. In the fully adjusted model, compared with participants with the lowest loneliness score (zero), hazard ratios (95% confidence interval) for CVD were 1.11 (1.02 and 1.20) and 1.26 (1.11 and 1.42) for participants with a loneliness scale of 1 and 2, respectively (P-trend < 0.001). No significant associations were observed for social isolation. Loneliness ranked higher in relative strength for predicting CVD than the lifestyle risk factors in diabetes patients. A significant additive interaction between loneliness and the degree of risk factor control on the risk of CVD was observed (P for additive interaction = 0.005). Conclusion Among diabetes patients, loneliness, but not social isolation scale, is associated with a higher risk of CVD and shows an additive interaction with the degree of risk factor control.

Funder

National Heart, Lung, and Blood Institute

National Institute of Diabetes and Digestive and Kidney Diseases

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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