Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women's Health Initiative Observational Study

Freeborne, Nancy; Simmens, Samuel J.; Manson, Jo Ann E.; Howard, Barbara V.; Cené, Crystal W.; Allison, Matthew; Corbie-Smith, Giselle; Bell, Christina; Denburg, Natalie L.; Martin, Lisa W.

doi:10.1097/gme.0000000000001297

Cited by 28 publications

(16 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The neuro-endocrine pathways that comprise the stress response are complex (Charney, 2004), but there is evidence for gender-specific stress responses (Bekhbat & Neigh, 2018), possibly due to a combination of the effects of estrogen (Bale & Epperson, 2015; Charney, 2004), differential recruitment of neural networks (Goldfarb, Seo, & Sinha, 2019), and social support (Ozbay et al, 2007). Women tend to report larger social networks with greater network ties for social support (Turner, 1994), which has been marginally associated with improved self-rated health (Caetano, Silva, & Vettore, 2013) and health outcomes (Freeborne et al, 2019; Uchino, Cacioppo, & Kiecolt-Glaser, 1996; Uphoff, Pickett, Cabieses, Small, & Wright, 2013). Recent findings have demonstrated that social support can buffer against negative mental health effects of neighborhood deprivation (Klijs, Mendes de Leon, Kibele, & Smidt, 2017) and that the buffering hypothesis is strongest for those experiencing the heaviest burden of stress exposure, including neighborhood disorder (Moskowitz, Vittinghoff, & Schmidt, 2013).…”

Section: Discussionmentioning

confidence: 99%

The relationship between neighborhood socioeconomic deprivation and telomere length: The 1999–2002 National Health and Nutrition Examination Survey

Powell‐Wiley

Gebreab

Claudel

et al. 2020

SSM - Population Health

View full text Add to dashboard Cite

Socioeconomically disadvantaged neighborhoods have been associated with poor health outcomes. Little is known about the biological mechanism by which deprived neighborhood conditions exert negative influences on health. Data from the 1999–2002 National Health and Nutrition Examination Surveys (NHANES) were used to assess the relationship between neighborhood deprivation index (NDI) and log-transformed leukocyte telomere length (LTL) via multilevel modeling to control for census tract level clustering. Models were constructed using tertiles of NDI (ref = low NDI). NDI was calculated using census tract level socioeconomic indicators from the 2000 U.S. Census. The sample (n = 5,106 adults) was 49.8% female and consisted of 82.9% non-Hispanic whites, 9.4% non-Hispanic blacks, and 7.6% Mexican Americans. Mean age was 45.8 years. Residents of neighborhoods with high NDI were younger, non-white, had lower educational attainment, and had a lower poverty to income ratio (all p < 0.0001). Neighborhood deprivation was inversely associated with LTL among individuals living in neighborhoods with medium NDI (β = −0.043, SE = 0.012, p = 0.0005) and high NDI (β = −0.039, SE = 0.013, p = 0.003). Among men, both medium (β = −0.042, SE = 0.015, p = 0.006) and high (β = −0.047, SE = 0.015, p = 0.001) NDI were associated with shorter LTL. Among women, only medium NDI (β = −0.020, SE = 0.016, p = 0.009) was associated with shorter LTL. After controlling for individual characteristics, including individual-level socioeconomic status, increasing neighborhood socioeconomic deprivation is associated with shorter LTL among a nationally representative sample of US adults. This suggests that telomere shortening may be a mechanism through which neighborhood deprivation results in poor health outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

The relationship between neighborhood socioeconomic deprivation and telomere length: The 1999–2002 National Health and Nutrition Examination Survey

Powell‐Wiley

Gebreab

Claudel

et al. 2020

SSM - Population Health

View full text Add to dashboard Cite

show abstract

“…A total score (range, 9-45) was calculated, with higher scores reflecting greater social support. Previous WHI studies have used this social support scale with postmenopausal women …”

Section: Methodsmentioning

confidence: 99%

Evaluation of Social Isolation, Loneliness, and Cardiovascular Disease Among Older Women in the US

et al. 2022

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Social isolation and loneliness are increasing public health concerns and have been associated with increased risk of cardiovascular disease (CVD) among older adults. OBJECTIVE To examine the associations of social isolation and loneliness with incident CVD in a large cohort of postmenopausal women and whether social support moderated these associations. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study, conducted from March 2011 through March 2019, included community-living US women aged 65 to 99 years from the Women's Health Initiative Extension Study II who had no history of myocardial infarction, stroke, or coronary heart disease.EXPOSURES Social isolation and loneliness were ascertained using validated questionnaires. MAIN OUTCOMES AND MEASURESThe main outcome was major CVD, which was physician adjudicated using medical records and included coronary heart disease, stroke, and death from CVD.Continuous scores of social isolation and loneliness were analyzed. Hazard ratios (HRs) and 95% CIs for CVD were calculated for women with high social isolation and loneliness scores (midpoint of the upper half of the distribution) vs those with low scores (midpoint of the lower half of the distribution) using multivariable Cox proportional hazards regression models adjusting for age, race and ethnicity, educational level, and depression and then adding relevant health behavior and health status variables. Questionnaire-assessed social support was tested as a potential effect modifier. RESULTS Among 57 825 women (mean [SD] age, 79.0 [6.1] years; 89.1% White), 1599 major CVD events occurred over 186 762 person-years. The HR for the association of high vs low social isolation scores with CVD was 1.18 (95% CI, 1.13-1.23), and the HR for the association of high vs low loneliness scores with CVD was 1.14 (95% CI, 1.10-1.18). The HRs after additional adjustment for health behaviors and health status were 1.08 (95% CI, 1.03-1.12; 8.0% higher risk) for social isolation and 1.05 (95% CI, 1.01-1.09; 5.0% higher risk) for loneliness. Women with both high social isolation and high loneliness scores had a 13.0% to 27.0% higher risk of incident CVD than did women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations (social isolation × social support: r, -0.18; P = .86; loneliness × social support: r, 0.78; P = .48). CONCLUSIONS AND RELEVANCEIn this cohort study, social isolation and loneliness were independently associated with modestly higher risk of CVD among postmenopausal women in the US, and women with both social isolation and loneliness had greater CVD risk than did those with either exposure alone. The findings suggest that these prevalent psychosocial processes merit increased attention for prevention of CVD in older women, particularly in the era of COVID-19.

show abstract

“…The current first-line recommendation for managing CVD risk is adopting healthy lifestyle behaviors, including eating a healthy diet, not smoking, being physically active, and managing weight [ 19 ]. Additionally, consistent medication management, access to professional care, social support, and psychological health have been identified as important factors for success [ 1 , 16 , 17 , 20 - 23 ]. However, there are many barriers that can interfere with self-management [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data

Montgomery¹,

Boucher²,

Honomichl³

et al. 2021

JMIR Cardio

View full text Add to dashboard Cite

Background The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD.

show abstract

Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women's Health Initiative Observational Study

Cited by 28 publications

References 65 publications

The relationship between neighborhood socioeconomic deprivation and telomere length: The 1999–2002 National Health and Nutrition Examination Survey

The relationship between neighborhood socioeconomic deprivation and telomere length: The 1999–2002 National Health and Nutrition Examination Survey

Evaluation of Social Isolation, Loneliness, and Cardiovascular Disease Among Older Women in the US

The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data

Contact Info

Product

Resources

About