Chronic loneliness linked to increased risk of stroke

A new study finds that adults over the age of 50 who report experiencing persistently high levels of loneliness have a 56% increased risk of stroke.

Although the increased stroke risk did not apply to individuals who reported experiencing situational loneliness, the researchers believe this finding supports the hypothesis that chronic loneliness is driving the association.

“Our findings suggest that people who experience chronic loneliness may be at higher risk of developing a stroke,” said lead researcher Yenny So, PhD, a social and behavioral sciences research fellow at the Harvard T.H. Chan School of Public Health in Boston. Medscape Medical News“It's important to assess loneliness regularly because if it goes unidentified or ignored, outcomes can worsen.”

The survey results are Publish online On June 24th Clinical Medicine.

Serious and chronic health effects

The COVID-19 pandemic has caused loneliness to reach an all-time high. 2023 Surgeon General's Report It highlighted the fact that loneliness and social isolation lead to serious and chronic health consequences.

Previous studies have linked loneliness to cardiovascular disease, but few have examined the association between loneliness and stroke risk. This is one of the first studies to examine the association between change in loneliness over time and stroke risk.

Researchers used data from the Health and Retirement Study from 2006 to 2018 to evaluate the association between loneliness and stroke incidence over time. Between 2006 and 2008, 12,161 study participants aged 50 years or older with no history of stroke answered questions from the Revised UCLA Loneliness Scale. From these responses, the researchers created a summary score of loneliness.

Four years later, between 2010 and 2012, the remaining 8,936 study participants answered the same 20 questions again. Based on their loneliness scores at the two time points, participants were divided into four groups:

1. Consistently low (those who had low scores on the loneliness scale at both baseline and follow-up)
2. Remission (those who had high scores at baseline but low scores at follow-up)
3. Recent onset (lower scores at baseline and higher scores at follow-up)
4. Consistently high (those who scored high at both baseline and follow-up)

Incidence of stroke was determined by participant report and medical record data.

Among participants who had loneliness measured only at baseline, 1,237 strokes occurred during follow-up from 2006 to 2018. Among participants who had two loneliness assessments over time, 601 strokes occurred during follow-up.

Even after controlling for social isolation, depressive symptoms, physical activity, BMI, and other health conditions, the researchers found that participants who reported being lonely at baseline had only a 25% increased risk of stroke compared with participants who did not report being lonely at baseline (hazard ratio[HR]0.018). [HR]1.25; 95% CI, 1.06-1.47).

Participants who consistently reported high levels of loneliness at both time points had a 56% increased risk of stroke compared with participants who did not report loneliness at both time points, after adjusting for social isolation and depression (HR, 1.56; 95% CI, 1.11-2.18).

The researchers did not explore underlying issues that may contribute to the association between loneliness and stroke risk, but they speculated that physiological factors may be involved, which could include inflammation caused by increased hypothalamic-pituitary-adrenal activity, behavioral factors such as poor medication adherence, smoking and/or alcohol use, and psychosocial issues.

“Those who experience chronic loneliness may represent individuals who are unable to develop or maintain satisfying social relationships, which may result in long-term interpersonal difficulties.

“Loneliness is a very subjective experience, so it is important to seek support and intervene to address the patient's specific personal needs. It is important to distinguish between loneliness and social isolation,” Dr So said.

She added, “By screening for loneliness and offering care or referring patients to appropriate behavioral health providers, clinicians can address loneliness and its associated health risks early and play a key role in reducing the population burden of loneliness.”

Progressive Research

Comments on the survey results Medscape Medical NewsElaine Jones, M.D., medical director of Access Telecare, who was not involved in the study, praised the researchers for “moving this topic forward by focusing on the chronic aspects of loneliness.”

She said more research is needed to explore loneliness as a risk factor for stroke, and noted there may be something inherently different between respondents who reported loneliness at both points in the study.

“Personality type may play a role here. We know that people with a positive attitude and outlook, with or without depression, weather difficult health conditions better than those with a negative attitude. Perhaps those who feel lonely initially decide to take action and join a group, take up a hobby or reconnect with family and friends. Perhaps those who feel chronically lonely don't or can't do this,” Jones said.

Chronic loneliness can cause stress, she added, “and we know that stress chemicals and hormones can be detrimental to health over the long term.”

This research was funded by the National Institute on Aging. No conflicts of interest were identified.