Download PDF
Int J Angiol
DOI: 10.1055/a-2552-8626
Original Article

Coronary Artery Disease and Loneliness: A Cross-Sectional Analysis using the Revised UCLA Loneliness Scale

Tanzim Bhuiya 
1   Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Jonathan H. Sussman
1   Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Francis O'Neill
2   Department of Cardiology, Nassau University Medical Center, Hempstead, New York
,
Tashina Dussie
3   Northwell, Cardiovascular Institute, New Hyde Park, New York
,
Gerard Dichiara
2   Department of Cardiology, Nassau University Medical Center, Hempstead, New York
,
Joseph Abraham
2   Department of Cardiology, Nassau University Medical Center, Hempstead, New York
,
Roman Zeltser
3   Northwell, Cardiovascular Institute, New Hyde Park, New York
4   Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
,
Amgad N. Makaryus 
3   Northwell, Cardiovascular Institute, New Hyde Park, New York
4   Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
5   Plainview Hospital, Plainview, New York
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Background

Loneliness has been identified as an important psychosocial factor associated with cardiovascular disease, but the relationship has been underexplored using validated measures.

Materials and Methods

This cross-sectional study analyzed 92 patients from 2018 to 2019 using the Revised UCLA Loneliness Scale to evaluate associations between loneliness and coronary artery disease (CAD). Statistical analysis was performed using R v4.4.0. A multivariate logistic regression model assessed the relationship between loneliness scores and CAD, adjusting for age and race/ethnicity. A one-sided Wilcoxon rank-sum test compared loneliness scores between CAD and non-CAD patients.

Results

Age was significantly associated with CAD (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01–1.08, p = 0.0084), whereas loneliness score showed a trend toward significance (OR: 1.03, 95% CI: 0.99–1.07, p = 0.140). No significant associations were found between race/ethnicity or sex and loneliness. In a subgroup analysis of patients ≥ 55 years, loneliness was significantly associated with CAD (OR: 1.06, 95% CI: 1.00–1.12, p = 0.04), whereas age was not (p = 0.378). Patients aged ≥ 55 years with CAD had significantly higher loneliness scores than those without CAD (p = 0.044), whereas no significant difference was observed in patients < 55 years (p = 0.87).

Conclusion

While loneliness was not independently associated with CAD in the overall cohort, it was significantly associated with CAD in patients aged ≥ 55 years. This suggests that loneliness may be a relevant factor in cardiovascular health among older adults. This emphasizes the need for health care providers to consider loneliness as a potential risk factor for CAD, alongside traditional risk factors.

Keywords

loneliness - coronary artery disease - risk factors - Revised UCLA Loneliness Scale

Ethical Approval

This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Nassau University Medical Center (IRB# 18-186).


Patients' Consent

Written informed consent was obtained from all participants prior to enrollment, ensuring adherence to ethical guidelines for human research.




Publication History

Article published online:
09 April 2025

© 2025. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Reddy KS. Global burden of disease study 2015 provides GPS for global health 2030. Lancet 2016; 388 (10053): 1448-1449
    PubMedSearch in Google Scholar
  • 2 Kwapong YA, Boakye E, Khan SS. et al. Association of depression and poor mental health with cardiovascular disease and suboptimal cardiovascular health among young adults in the United States. J Am Heart Assoc 2023; 12 (03) e028332
    PubMedSearch in Google Scholar
  • 3 Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999; 99 (16) 2192-2217
    CrossrefPubMedSearch in Google Scholar
  • 4 Ding L, Dai R, Qian J. et al. Psycho-social dimensions of cardiovascular risk: exploring the impact of social isolation and loneliness in middle-aged and older adults. BMC Public Health 2024; 24 (01) 2355
    PubMedSearch in Google Scholar
  • 5 Santosa A, Rosengren A, Ramasundarahettige C. et al. Psychosocial risk factors and cardiovascular disease and death in a population-based cohort from 21 low-, middle-, and high-income countries. JAMA Netw Open 2021; 4 (12) e2138920
    PubMedSearch in Google Scholar
  • 6 Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart 2016; 102 (13) 1009-1016
    CrossrefPubMedSearch in Google Scholar
  • 7 Yu B, Steptoe A, Chen L-J, Chen YH, Lin CH, Ku PW. Social isolation, loneliness, and all-cause mortality in patients with cardiovascular disease: a 10-year follow-up study. Psychosom Med 2020; 82 (02) 208-214
    PubMedSearch in Google Scholar
  • 8 Tiwari SC. Loneliness: a disease?. Indian J Psychiatry 2013; 55 (04) 320-322
    PubMedSearch in Google Scholar
  • 9 Ausín B, Muñoz M, Martín T, Pérez-Santos E, Castellanos MÁ. Confirmatory factor analysis of the Revised UCLA Loneliness Scale (UCLA LS-R) in individuals over 65. Aging Ment Health 2019; 23 (03) 345-351
    PubMedSearch in Google Scholar
  • 10 Perlman D, Gerson AC, Spinner B. Loneliness among senior citizens: an empirical report. Essence: Issues in the Study of Ageing, Dying, and Death 1978
    PubMedSearch in Google Scholar
  • 11 Russell D, Peplau LA, Ferguson ML. Developing a measure of loneliness. J Pers Assess 1978; 42 (03) 290-294
    PubMedSearch in Google Scholar
  • 12 Sharma T, Padala PR, Mehta JL. Loneliness and social isolation: determinants of cardiovascular outcomes. Curr Cardiol Rev 2021; 17 (06) e051121190873
    PubMedSearch in Google Scholar
  • 13 Leigh-Hunt N, Bagguley D, Bash K. et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health 2017; 152: 157-171
    CrossrefPubMedSearch in Google Scholar
  • 14 Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: results from two population-based studies. Res Aging 2004; 26 (06) 655-672
    PubMedSearch in Google Scholar
  • 15 Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol 1980; 39 (03) 472-480
    PubMedSearch in Google Scholar
  • 16 Russell DW. UCLA Loneliness Scale (Version 3): reliability, validity, and factor structure. J Pers Assess 1996; 66 (01) 20-40
    PubMedSearch in Google Scholar
  • 17 Bruce LD, Wu JS, Lustig SL, Russell DW, Nemecek DA. Loneliness in the United States: a 2018 national panel survey of demographic, structural, cognitive, and behavioral characteristics. Am J Health Promot 2019; 33 (08) 1123-1133
    PubMedSearch in Google Scholar
  • 18 Clark DMT, Loxton NJ, Tobin SJ. Declining loneliness over time: evidence from American colleges and high schools. Pers Soc Psychol Bull 2015; 41 (01) 78-89
    PubMedSearch in Google Scholar
  • 19 Arnett DK, Blumenthal RS, Albert MA. et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation 2019; 140 (11) e596-e646
    PubMedSearch in Google Scholar
  • 20 Sunayama S, Daida H, Mokuno H. et al. Lack of increased coronary atherosclerotic risk due to elevated lipoprotein(a) in women > or = 55 years of age. Circulation 1996; 94 (06) 1263-1268
    PubMedSearch in Google Scholar
  • 21 Dugani SB, Moorthy MV, Li C. et al. Association of lipid, inflammatory, and metabolic biomarkers with age at onset for incident coronary heart disease in women. JAMA Cardiol 2021; 6 (04) 437-447
    CrossrefPubMedSearch in Google Scholar
  • 22 Roger VL, Go AS, Lloyd-Jones DM. et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation 2012; 125 (01) e2-e220
    PubMedSearch in Google Scholar
  • 23 Fakhry SM, Morse JL, Garland JM. et al. Redefining geriatric trauma: 55 is the new 65. J Trauma Acute Care Surg 2021; 90 (04) 738-743
    PubMedSearch in Google Scholar
  • 24 Wiemers EE, Lin I-F, Wiersma Strauss A, Chin J, Hotz VJ, Seltzer JA. Age differences in experiences of pandemic-related health and economic challenges among adults aged 55 and older. Gerontologist 2024; 64 (06) gnae023
    PubMedSearch in Google Scholar
  • 25 Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci 2015; 10 (02) 227-237
    CrossrefPubMedSearch in Google Scholar
  • 26 Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med 2010; 7 (07) e1000316
    CrossrefPubMedSearch in Google Scholar
  • 27 Valtorta NK, Kanaan M, Gilbody S, Hanratty B. Loneliness, social isolation and risk of cardiovascular disease in the English Longitudinal Study of Ageing. Eur J Prev Cardiol 2018; 25 (13) 1387-1396
    PubMedSearch in Google Scholar
  • 28 Paul E, Bu F, Fancourt D. Loneliness and risk for cardiovascular disease: mechanisms and future directions. Curr Cardiol Rep 2021; 23 (06) 68
    PubMedSearch in Google Scholar
  • 29 Hodgson S, Watts I, Fraser S, Roderick P, Dambha-Miller H. Loneliness, social isolation, cardiovascular disease and mortality: a synthesis of the literature and conceptual framework. J R Soc Med 2020; 113 (05) 185-192
    PubMedSearch in Google Scholar
  • 30 Xia N, Li H. Loneliness, social isolation, and cardiovascular health. Antioxid Redox Signal 2018; 28 (09) 837-851
    PubMedSearch in Google Scholar
  • 31 Cacioppo S, Capitanio JP, Cacioppo JT. Toward a neurology of loneliness. Psychol Bull 2014; 140 (06) 1464-1504
    PubMedSearch in Google Scholar
  • 32 Li H, Xia N. The role of oxidative stress in cardiovascular disease caused by social isolation and loneliness. Redox Biol 2020; 37: 101585
    PubMedSearch in Google Scholar
  • 33 Iob E, Steptoe A. Cardiovascular disease and hair cortisol: a novel biomarker of chronic stress. Curr Cardiol Rep 2019; 21 (10) 116
    PubMedSearch in Google Scholar
  • 34 Brown EG, Gallagher S, Creaven AM. Loneliness and acute stress reactivity: a systematic review of psychophysiological studies. Psychophysiology 2018; 55 (05) e13031
    PubMedSearch in Google Scholar
  • 35 Wenn P, Meshoyrer D, Barber M. et al. Perceived social support and its effects on treatment compliance and quality of life in cardiac patients. J Patient Exp 2022 ;9:23743735221074170
    PubMedSearch in Google Scholar
  • 36 Lee SL, Pearce E, Ajnakina O. et al. The association between loneliness and depressive symptoms among adults aged 50 years and older: a 12-year population-based cohort study. Lancet Psychiatry 2021; 8 (01) 48-57
    PubMedSearch in Google Scholar
  • 37 Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med 2010; 40 (02) 218-227
    PubMedSearch in Google Scholar
  • 38 Park C, Majeed A, Gill H. et al. The effect of loneliness on distinct health outcomes: a comprehensive review and meta-analysis. Psychiatry Res 2020; 294: 113514
    CrossrefPubMedSearch in Google Scholar
  • 39 Chaddha A, Robinson EA, Kline-Rogers E, Alexandris-Souphis T, Rubenfire M. Mental health and cardiovascular disease. Am J Med 2016; 129 (11) 1145-1148
    CrossrefPubMedSearch in Google Scholar
  • 40 Riba M, Wulsin L, Rubenfire M, Ravindranath D. Psychiatry and Heart Disease: The Mind, Brain, and Heart. John Wiley & Sons; 2012
    Search in Google Scholar
  • 41 James GD, Yee LS, Harshfield GA, Blank SG, Pickering TG. The influence of happiness, anger, and anxiety on the blood pressure of borderline hypertensives. Psychosom Med 1986; 48 (07) 502-508
    PubMedSearch in Google Scholar
  • 42 Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 2006; 48 (08) 1527-1537
    PubMedSearch in Google Scholar
  • 43 Rajan S, McKee M, Rangarajan S. et al; Prospective Urban Rural Epidemiology (PURE) Study Investigators. Association of symptoms of depression with cardiovascular disease and mortality in low-, middle-, and high-income countries. JAMA Psychiatry 2020; 77 (10) 1052-1063
    PubMedSearch in Google Scholar
  • 44 D'Acquisto F. Affective immunology: where emotions and the immune response converge. Dialogues Clin Neurosci 2017; 19 (01) 9-19
    PubMedSearch in Google Scholar
  • 45 Kraav S-L, Awoyemi O, Junttila N. et al. The effects of loneliness and social isolation on all-cause, injury, cancer, and CVD mortality in a cohort of middle-aged Finnish men. A prospective study. Aging Ment Health 2021; 25 (12) 2219-2228
    PubMedSearch in Google Scholar
  • 46 Gierveld J, van Tilburg T, Dykstra P. Loneliness and Social Isolation. Natl Inst Aging 2006
    PubMedSearch in Google Scholar