Owner of a Lonely Heart

Owner of a Lonely HeartWhat is loneliness? Think about it for a second. Can you put it into words?

If you can, I guess you will associate it with sadness and isolation. But, although loneliness is usually associated with social isolation, it is important to discriminate between these two things. Social isolation refers to a lack of contact with other people, while loneliness indicates a state of mind.

Loneliness is as a subjective feeling of isolation, not belonging, or lacking companionship. It reflects a discrepancy between one’s desired and actual social relationships. A person can feel lonely despite living with a spouse or other family members. We can experience loneliness in a room full of people.

Many scientific studies have indicated an association between social isolation, loneliness and heart disease. Furthermore, loneliness is often associated with diminished physical activity, depression, disrupted sleep and impaired daytime functioning, increased blood pressure, impaired mental and cognitive function, increased risk of dementia, and altered immunity.

Furthermore, there is evidence that loneliness can contribute to functional decline and premature death independently of other physical, behavioral, or psychological factors. In fact, I find this quite scary considering how seldom the health risks of loneliness and social isolation are highlighted in comparison to other risk factors.

One of the first studies presented at this week’s American Congress of Cardiology Annual Meeting in Washington D.C. was a survey of 3.5 million Americans collected at over 20 thousand sites suggesting that being married decreases the risk of cardiovascular disease by 5 percent. After adjusting for age, sex, race and other cardiovascular risk factors, researchers found that marital status was independently associated with cardiovascular disease. Overall, married subjects had lower rates of stroke, coronary artery disease and disease of the arteries of the lower extremities.  The study was conducted from 2003 through 2008 at more than 20,000 screening sites in all 50 states. The average age was 64 years, and 63% of the participants were women. Almost 90% were white.

The study also found that smoking, a major risk to heart health, was highest among divorced people. Widowed people had the highest rates of high blood pressure, diabetes and inadequate exercise. Obesity was most common in those single and divorced, and widowed people suffered from the highest rates of diabetes, high blood pressure and inadequate exercise.

It is quite likely that if you have a spouse you may be more willing to look after yourself. You may be less likely to smoke and more compliant with a healthy diet and exercise. You may even be more willing to follow up medical appointments. The fact that married couples look after each other could be important.

Obviously, being married will reduce the risk of loneliness and social isolation. Interestingly, being divorced or widowed was associated with any form of cardiovascular disease, compared with never being married. This suggest that the loss of a spouse or a close one may be a risk factor in itself.

The INTERHEART study published in 2004 was a large study of risk factors for a first heart attack among 11.000 patients worldwide who were compared with 13.000 matched controls. Stressful life events occurred more frequently within the prior year among patients with heart attack than among the controls. These life events included marital separation or divorce, loss of job or retirement, loss of crop or business failure, violence, major intrafamily conflict, major personal injury or illness, death or a major illness of a close family member, death of a spouse, or other major stress.

I always find the story of the Rosetans helpful in order to understand the importance of family relations and social surroundings for the risk of heart disease. Roseto is an Italian-American town in eastern Pennsylvania. In the early 1960’s a local physician, Dr. Benjamin Falcone, who had been practicing in Roseto for 17 years pointed out that he rarely saw a case of heart attack in any of the 1600 inhabitants of Roseto under age of 65. Subsequently it was confirmed that from 1955 to 1965 the death rate from heart attack was markedly lower than in nearby communities and the rest of the country. However, the usually accepted risk factors were not less common in Roseto than elsewhere. The men spent their days doing hazardous labor in underground slate mines. Smoking was common. The traditional Italian food had been Americanized, and could not be considered heart healthy. So why weren’t Rosetans dropping dead with heart disease?

Dr. Stewart Wolf and coworkers describe the social and family structure of the inhabitants of Roseto: “The Roseto that we saw in the early 1960s was sustained by the traditional value of southern Italian villagers. The family, not the individual, was the unit of their society. The community was their base of operations and each inhabitant felt a responsibility for its welfare and quality. Most household contained three generations.

Rosetans were proud and happy, generous, hospitable and ready to celebrate any small triumph of their citizens. The elderly were not only cherished but, instead of being retired from family and community responsibilities, they were promoted to the ‘supreme court’. There was no shortage of stress among Rosetans. They experienced many of the same social problems and personal conflicts as their neighbors, but they had a philosophy of cohesion with powerful support from family and neighbor and deep religious convictions to shield them against and counteract the stresses”.

The so-called “Roseto effect” is interesting because it teaches us about how people can be shielded from the effect of stressful input, thereby limiting its damaging effects on the cardiovascular system. The important thing is to realize that all the traditional stressors were present among the Rosetans. However the strong emphasis on the family, and not the individual as the unit of their society, appeared to protect the people from the harmful effects of stress on the heart. This is believed to have significantly reduced the incidence of acute heart attack among the Rosetan people.

Lately, the discussion on how to prevent or reduce the risk of heart disease has to a high degree evolved around other factors such as metabolic abnormalities, cholesterol, dietary fat and whether or not statin drugs should be used or not. However, strengthening our social network and family relations could be just as important as lowering cholesterol.

On a lighter note; Don’t spend too much time worrying about fats and cholesterol. Go get married instead.