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.


  1. Lee Maniscalco says

    Very important point. Dr. James Lynch wrote “The Broken Heart: the medical consequences of loneliness” (1977) on the same topic. A valuable perspective.

  2. Someone says

    I really appreciate Axel that every once in a while you remember to raise these kind important views that so easily gets forgotten.

    It’s funny how little attention in general is given for this approach, despite of the fact that we have physical reaction to all of our emotions. Actually the physical part of the emotion begins before the emotion even comes to our awareness. If we are chronically depressed or just stressed it has really negative impact to our well-being.

    By the way, have you paid attention that when you write about heart disease from this kind of approach, the discussion here is much more quiet. I think it reflects how the “science community” in general reacts for this kind views. It’s simply not as interesting, because it’s harder to measure than cholesterol or something other biomarker and that’s why it does not get the attention it deserves.

    • Axel F Sigurdsson says

      Thanks Someone.
      You’re absolutely right. We tend to underestimate the association between social isolation, loneliness, depression and personality traits on the risk of heart disease. Public health authorities should pay more attention to these issues. I agree that one of the reasons is that these factors are hard to measure. Maybe some of us see also believe that this is just something we can’t influence or change. But I don’t believe that’s right. I think social isolation is a much bigger problem in today’s world than it used to be. Paying attention and educating people about the importance of relations, family, friends etc. is the first step I guess…

  3. Someone says

    I think that for sure you can influence on it as well. Of course it’s not always as easy and straightforward as getting statins or something drug everyone morning :). It requires more psychological approach.

    Measuring is hard, yes. Do you know if there is any studies that would have long term HRV follow up and it’s impact for example on heart disease ? Or some other indicators of stress for example. I know there is some studies looking for correlation between cortisol levels and heart disease, but in those too, it’s quite often just the morning measurement of cortisol, while the 24h cortisol could give us some what different insights.

  4. says

    Yeh, that’s right. My obese older 50yr old brother doesn’t worry too much. He works a lot, sleeps irregularly, drinks a lot of beer, ocassionally smokes, eats sweets, drinks coffee, but he is happy and has no health problems, even no hypertension, no diabetes etc.

    I, 37yr old, have higher material status, higher education, trying to eat healthy, do some excersises, sleep well, avoid sweets and large amounts of coffe, drinking ocassionally only wine, a bit obese (BMI 30) – but still fighting with it and loosing some kgs, I have hypertension (and who knows what more) and two episodes of AFib. But I am unhappy, unsatisfied, nervous, depressed and hating my job. Even my hobby (photography) gives me no satisfaction (due to the fact I actually have no time to practice it). I’m still tired, having problems with sleep due to bradycardia after betablockers, what makes me more stresfull.

    My 76yr old dad gave up 10 years ago taking betablockers after one week, after he stated that he had headache using them. And he lives until today with no medicaments (besides one for diabetes II), by the way he actually doesn’t worry about anything.

    But is the lack of stress giving both of them relatively healthy life? For sure, but in fact, I have desk job, sitting 8h a day behind desk, and my brother have more physical work and my dad also do a lot of work around the house. They are both obese, but relatively mobile and almost no stress and problems.

  5. Catherine Powers says

    Hi Doc

    I am deeply appreciative of your comments on this issue of loneliness and it’s impact on physical health. I am both a PhD psychologist and a nurse. My husband and I have had a series of losses in our families over the past few years. We also moved two years ago 2000 miles away from our family and friends for work purposes. I have felt increasingly lonely over the course of these two years, and my health has declined. Trying to intervene in this, yesterday I flew the 2000 miles back to where my family and friends are. I am here at our friends’ home designing a cardiac healthy diet for a friend who has had one heart attack and is continuing to have chest pain. I feel that being together and working on this problem has gotten rid of my loneliness, and hopefully it will help his outcome. I hope my husband doesn’t become overwhelmingly lonely while I am gone! Thank you again for such a thoughtful article.

    • Axel F Sigurdsson says

      Thanks for sharing your thoughts Catherine. I appreciate it. The emotional issues, family and relationship are more important for our general health than we often realize.

  6. michael goroncy says

    I say Yo! Dr Catherine
    Care to enlighten us with your “Cardiac health diet” protocol?

    • Catherine Powers says

      Hi there! Well, To begin with, this fellow I’m talking about is really into unhealthy eating habits on a long-term basis. He has a long-standing history of a lot of inflammation throughout his body. So, just starting out with a lot of fresh produce and all food and spuce that I can find that he’ll eat that is anti-inflammatory. He’s also a sugar addict, so I’m helping to make him substitutes for the junk food desserts that he tends to eat daily. Overall healthier foods for starters. More foods with omega 3’s, etc. We’ll see where he goes from there. Hopefully, his cardiologist will order more extensive lab work to make it clearer what he’s dealing with.

  7. michael goroncy says

    Sounds like you are “Pushing shit uphill” Catherine.
    On the one hand…..I say let them die, if not prepared to make an effort. And on the other! Well, I best qualify that by saying:
    (1) 65yo M
    (2) Infarct and CABG at 38
    (3) Smoke 30 fags and drink a litre of wine daily
    (4) Pumping along with one coronary artery, controlled with 8 cardio drugs
    (5) Macro and micro nutrients to the max. as I currently understand
    (6) Add ons ….best left for another time
    (7) Pathology and lipids…..excellent

    Would like others to chip in here…..and we can make a real mess and in-conclusion.

    • Catherine Powers says

      Sorry to hear you’re pushing a ship uphill. Sounds like a tough one. My pal (65 y.o.) doesn’t smoke or drink, so he doesn’t have additional risks that complicate matters. The only factors that I’m currently aware of that he can influence are his diet and his psychological state. It feels more hopeful to work on what he/we can together. Plus, I think he needs a more knowledgable or aggressive cardiologist. I say that because his doctor never recommended any lifestyle changes.

  8. michael goroncy says

    Totally agree with your approach Catherine.
    I believe aggressive treatment is the path to follow in your friends case.
    (1) Find a GP/PCP who is not afraid to order pathology tests….Lipids including LPa, APOB,H-CRP,Homocystein,BNP….nearly all can be brought to optimal with nutrition and micronutrients.
    (2) Interventional Cardiologist that your friend has a good rapport with.
    (3) Nutrition and activity….not the useless trash published in magazines. Can supply my approach if you wish.
    (4) Keep in mind, his current ‘chest pains’ may not be heart related, but an anxiety disorder which can follow a event and the symptoms run parallel.

    Apologies to Axel for going of topic…(Lonely Heart) which is a major player in all disease.
    (1) It is better to be alone than in a stressful relationship.
    (2) Having a partner that your comfortable and at ease with is fantastic medicine.

    My Lipids were sub-standard prior to tweaking my diet. Since my teens I had hovered around 100kg. I became suspicious of wheat/gluten about 12 years ago, and eliminated it. Within 5 months my weight dropped to around 80kg and has remained so ever since…BMI 24.. ..basically LC/HF diet, which may not be suitable for your friend. I guess you need to customise accordingly.

    My current lipids (although I am not convinced that the current guidelines and conflicts of interest and polotics involved may not be correct…that is all we have)

    Fasting Test:
    Total chol.=3.5 mmol/L
    Trigs=0.7 (they were 2.7) 10 years ago
    CRP=1.9 (not great)
    Homocystein=12.6 (shithouse)
    APO B =0.48 g/l
    Lpa=0.02 g/l

    • Axel F Sigurdsson says

      Good point. Of course being married is not the real issue when it comes to stress. In fact, marital problems have been shown to be associated with risk.
      For example a study of marital stress on the incidence of coronary heart disease in a cohort of Stockholm women followed for 5 years, marital stress was associated with a 2.9 fold increased risk of recurrent events, whereas work stress did not predict the risk of coronary events. Similar data are available for men from the MRFIT trial (Multiple Risk Factor Intervention Trial). That trial showed that chronic work stress and marital dissolution increased the risk of cardiovascular mortality in men who were followed for nine years.
      So getting married or staying married is not always the solution. It’s all about probability. Therefore, when studying large groups of individuals, those who are married are less likely to suffer stress associated with social isolation. There may of course be other types of stress in a relationship.

    • Catherine Powers says

      Thank you for your thoughtful response, Michael. Would be happy to know your nutritional and activity approach. My friend is having a stress test today and likely an angiogram ASAP. He has angina and cannot walk far without chest pain. I don’t think his cardiologist is aggressive enough, and I hope my friend gets a new doc. Our conversation fits here because if my pal passes on, I’ll be more lonely, for sure. ;-)

  9. michael goroncy says

    Yo! Axel
    Thanks for the 2 links. The first study, as you know was small with novel findings, and is of no significance. However, the second study was compelling.
    Your point re: ‘social isolation’ has overwhelming evidence of it’s impact on longevity.

    An example of stress in a relationship…..A friend of mine (lets call him me) was married for 18yrs and the majority of that time stressed the ‘bejeezus’ out of him. Constantly having chest tightness, frustration and confusion.
    After a few years, he re-married and has been for the last 11 yrs. And do you know? In that period he has not had any of the above 3 symptoms…not even once.

    The moral of the story is:….fill in your own.

  10. michael goroncy says

    Hi Catherine…I can only relay my own experience on the path of living with CHD.
    Your friend appears to need either surgery (PCI..stent) or CABG. Or aggressive medication treatment. The fact that he suffers chest pain on exertion, hopefully he gets a diagnosis with a angiography. You can’t treat anything until you know the cause. But, you know all that.

    Two things that are important are: the standard of care (what country?) and if he has medical insurance.

    I have seen more disgusting behaviour from doctors and hospitals than I have seen that made me feel confident and impressed by.
    “Good health is bad for business”….but that’s politics (sorry) venting my frustration.

    Anyway, your friends situation lies in 2 parts.
    What others will do for him and what he will do for himself.

    (A) Medical diagnosis and treatment.
    (B) Nutrition and activity….this is where he comes in. Doctors are not trained or savvy re: nutrition and are not to be blamed for their ignorance on that front.

    Although I know that my smoking and drinking will shorten my life, does not disqualify me from out-laying a protocol that I use to stay afloat.
    I don’t like long posts (boring)…will continue shortly.

Let me know what you think!