ArticlePsychosomatic medicine2014
Social integration and mortality in patients with coronary heart disease: findings from the Heart and Soul Study.
Article in Psychosomatic medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Loneliness, social isolation, and living alone: a comprehensive systematic review, meta-analysis, and meta-regression of mortality risks in older adults.Aging clinical and experimental research · 2025Pooled it
- A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality.Nature human behaviour · 2023Pooled it
- Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies.PloS one · 2023Pooled it
- The association of social support with functional status and physical activity in patients with coronary heart disease from The Heart and Soul study.BMC cardiovascular disorders · 2025Article
- Social Networks of Adolescents and Young Adults with Cancer: A Cross-Sectional Study.Current oncology (Toronto, Ont.) · 2025Article
- Impact of social isolation on mortality and morbidity in 20 high-income, middle-income and low-income countries in five continents.BMJ global health · 2021Observational
- Social integration and inflammation in individuals with and without posttraumatic stress disorder.Brain, behavior, and immunity · 2020Article
- 2019 Novel Coronavirus Disease, Crisis, and Isolation.Frontiers in psychology · 2020Article
- A proinflammatory diet is associated with inflammatory gene expression among healthy, non-obese adults: Can social ties protect against the risks?Brain, behavior, and immunity · 2019Article
- Social Integration, Social Support, and All-Cause, Cardiovascular Disease and Cause-Specific Mortality: A Prospective Cohort Study.International journal of environmental research and public health · 2019Article
- Health risks associated with social isolation in general and in young, middle and old age.PloS one · 2019Article
- Improving Medication Adherence in Coronary Heart Disease.Current cardiology reports · 2017Review
- Social Integration and Reduced Risk of Coronary Heart Disease in Women: The Role of Lifestyle Behaviors.Circulation research · 2017Article
- Influence of Social Engagement on Mortality in Korea: Analysis of the Korean Longitudinal Study of Aging (2006-2012).Journal of Korean medical science · 2016Article
- The social network index and its relation to later-life depression among the elderly aged ≥80 years in Northern Thailand.Clinical interventions in aging · 2016Article
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo determine why lower social integration predicts higher mortality in patients with coronary heart disease (CHD).
methodsThe association between social integration and mortality was examined prospectively in 1019 outpatients with stable CHD from the Heart and Soul Study. Baseline social integration was assessed with the Berkman Social Network Index. Cox proportional hazards models were used to determine the extent to which demographic and disease-relevant confounders and potential biological, behavioral, and psychological mediators explained the association between social integration and mortality.
resultsDuring a mean (standard deviation) follow-up period of 6.7 (2.3) years, the age-adjusted annual rate of mortality was 6.3% among socially isolated patients and 4.1% among nonisolated patients (age-adjusted hazard ratio [HR] = 1.61, 95% confidence interval [CI] = 1.26-2.05, p < .001). After adjustment for demographic and disease-relevant confounders, socially isolated patients had a 50% greater risk of death than did nonisolated patients (HR = 1.50, 95% CI = 1.07-2.10). Separate adjustment for potential biological (HR = 1.53, CI = 1.05-2.25) and psychological mediators (HR = 1.52, CI = 1.08-2.14) did not significantly attenuate this association, whereas adjustment for potential behavioral mediators did (HR = 1.30, CI = 0.91-1.86). C-reactive protein and hemoglobin A1c were identified as important biological and omega-3 fatty acids, smoking, and medication adherence as important behavioral potential mediators, with smoking making the largest contribution.
conclusionsIn this sample of outpatients with baseline stable CHD, the association between social integration and mortality was largely explained by health-related behavioral pathways, particularly smoking.
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