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      Loneliness and Risk for Cardiovascular Disease: Mechanisms and Future Directions

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          Abstract

          Purpose of review

          In this review, we synthesise recent research on the association between loneliness and cardiovascular disease (CVD). We present evidence for mechanisms underlying this association and propose directions for future research.

          Recent findings

          Loneliness is related to increased risk of early mortality and CVD comparable to other well-established risk factors such as obesity or smoking.

          Summary

          Loneliness has been linked to higher rates of incident CVD, poorer CVD patient outcomes, and early mortality from CVD. Loneliness likely affects risk for these outcomes via health-related behaviours (e.g. physical inactivity and smoking), biological mechanisms (e.g. inflammation, stress reactivity), and psychological factors (e.g. depression) to indirectly damage health.

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          Most cited references76

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          Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

          Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.
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            Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty

            Most older individuals develop inflammageing, a condition characterized by elevated levels of blood inflammatory markers that carries high susceptibility to chronic morbidity, disability, frailty, and premature death. Potential mechanisms of inflammageing include genetic susceptibility, central obesity, increased gut permeability, changes to microbiota composition, cellular senescence, NLRP3 inflammasome activation, oxidative stress caused by dysfunctional mitochondria, immune cell dysregulation, and chronic infections. Inflammageing is a risk factor for cardiovascular diseases (CVDs), and clinical trials suggest that this association is causal. Inflammageing is also a risk factor for chronic kidney disease, diabetes mellitus, cancer, depression, dementia, and sarcopenia, but whether modulating inflammation beneficially affects the clinical course of non-CVD health problems is controversial. This uncertainty is an important issue to address because older patients with CVD are often affected by multimorbidity and frailty - which affect clinical manifestations, prognosis, and response to treatment - and are associated with inflammation by mechanisms similar to those in CVD. The hypothesis that inflammation affects CVD, multimorbidity, and frailty by inhibiting growth factors, increasing catabolism, and interfering with homeostatic signalling is supported by mechanistic studies but requires confirmation in humans. Whether early modulation of inflammageing prevents or delays the onset of cardiovascular frailty should be tested in clinical trials.
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              An overview of systematic reviews on the public health consequences of social isolation and loneliness

              Social isolation and loneliness have been associated with ill health and are common in the developed world. A clear understanding of their implications for morbidity and mortality is needed to gauge the extent of the associated public health challenge and the potential benefit of intervention.
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                Author and article information

                Contributors
                e.paul@ucl.ac.uk
                f.bu@ucl.ac.uk
                d.fancourt@ucl.ac.uk
                Journal
                Curr Cardiol Rep
                Curr Cardiol Rep
                Current Cardiology Reports
                Springer US (New York )
                1523-3782
                1534-3170
                7 May 2021
                7 May 2021
                2021
                : 23
                : 6
                : 68
                Affiliations
                GRID grid.83440.3b, ISNI 0000000121901201, Department of Behavioural Science and Health, , University College London, ; 1-19 Torrington Place, London, WC1E 7HB UK
                Author information
                http://orcid.org/0000-0002-9193-3740
                Article
                1495
                10.1007/s11886-021-01495-2
                8105233
                33961131
                dfa30619-fbaa-42ad-8f41-5f7da6dce68e
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 9 March 2021
                Funding
                Funded by: UK Research and Innovation
                Award ID: ES/S002588/1
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 205407/Z/16/Z
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000269, Economic and Social Research Council;
                Award ID: ES/T006994/1
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000275, Leverhulme Trust;
                Award ID: PLP-2018-007
                Award Recipient :
                Categories
                Psychological Aspects of Cardiovascular Diseases (A Steptoe and IM Kronish , Section Editors)
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2021

                Cardiovascular Medicine
                loneliness,cardiovascular disease,epidemiology,health policy,health promotion

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