12: Don’t Leave Your Mom Alone

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788582We are in March, a month that marks international women’s day and also mothers’ day in the middle east, some African countries, and many European countries. Speaking of women's health, we tend to focus emotionally on depression, breast cancer, and osteoporosis. Whereas in fact, cardiovascular disease is the leading cause of death in women with roughly one out of every five deaths being due to CV disease.And we are familiar with the classic risk factors for coronary artery disease are diabetes, hypertension, dyslipidemia, smoking, etc but other factors can also modify the development of atherosclerotic and thrombotic disease. Nontraditional risk factors like social background, ethnicity, race, income, education, social support, etc. And we are exposed to social stresses throughout life. But as people grow older, life changes; retirement, deaths of family members and friends, and decreasing activities of daily living. These life changes contribute to decreasing social network size. And women, particularly older ladies, tend to experience more social isolation than men because they are more likely to be widowed, live alone, and get lower incomes.Today I chose a paper published in the JAMA open last February. The paper tested the impact of two, potential social determinants of disease; namely loneliness and social isolation. And we need to differentiate the two. Social isolation is the objective measure of social interactions and relationships, loneliness is the subjective feeling of being socially isolated. The researchers looked at 57,825 healthy American ladies 65 years old and above. None of them had any coronary disease or stroke. This was part of the investigation called the women's health initiative extension II. They followed those old but healthy ladies for 8 years from 2011 until 2019They measured a social isolation index score based on marital status, living situation, and frequency of social activities. Participants answered questions about being married or not, living alone, how often do you meet family and friends or call them by phone, how frequently do you go out to religious places, cinema, eat outside or go shopping. A higher score meant worse social isolation. They also measured loneliness using a scale based on questions that reflected feelings of isolation, lack of companionship, and being left out. Again, a higher score meant more loneliness. They also looked at other variables like diabetes, depression, the level of social support, the quality of the diet, and the level of physical activity. Women with the (higher) worst loneliness scores have a 14% higher chance of cardiovascular disease. Women with worse social isolation scores also had an 18% higher chance of cardiovascular disease. So now, social isolation and loneliness can be considered risk factors for coronary artery disease. What’s the explanation? Over time, the experiences of social isolation and feelings of loneliness disturb autonomic function, increase systolic blood pressure control, and evoke an inflammatory response. These may lead to hypertension and atherosclerosis. The study has limitations, of course. It was just an observational study. But it highlights the need for further research to evaluate the effectiveness of whatever interventions to reduce social isolation and loneliness and see if they can mitigate CVD risk or not. But what we are sure of is that we need to measure social isolation and loneliness in primary care. Maybe we also need to increase referrals for mental health assessments which can be done aided by AI. But the bottom line is loneliness and social isolation are bad for your mothers’ heart. So, no matter what, don’t leave your mom alone!