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Living Alone and Cardiovascular Risk in Outpatients at Risk of or With Atherothrombosis
Study Questions:
What is the impact of living alone on increased cardiovascular (CV) risk and mortality across international populations of outpatients at risk of, or with, atherothrombosis?
Methods:
The authors investigated whether living alone was associated with increased mortality and CV risk in the global REduction of Atherothrombosis for Continued Health (REACH) Registry. Stable outpatients at risk of or with atherothrombosis were recruited from December 1, 2003, through December 31, 2004, and followed up to 4 years for CV events. Events were examined by living arrangement with risk adjustment for age, sex, clinical risk factors, therapy, pre-existing vascular disease, and sociodemographic factors. Effect modification was tested by age, sex, employment, ethnicity, education, and geography.
Results:
Among the 44,573 REACH participants, 8,594 (19%) were living alone. Living alone was associated with higher 4-year mortality (14.1% vs. 11.1%) and CV death (8.6% vs. 6.8%; log-rank p < 0.01 for both comparisons); however, there was significant effect modification by age (p value for interaction = 0.03). Specifically, among younger participants, living alone compared with those living with others was associated with higher mortality (age 45-65 years: 7.7% vs. 5.7%; adjusted hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.01-1.51; age 66-80 years: 13.2% vs. 12.3%; adjusted HR, 1.12; 95% CI, 1.01-1.26), but this was not observed among older participants (age >80 years: 24.6% vs. 28.4%; adjusted HR, 0.92; 95% CI, 0.79-1.06). A similar trend was observed for the risk of CV death.
Conclusions:
The authors concluded that living alone was associated with increased mortality among all but the most elderly patients.
Perspective:
In this large contemporary international cohort with or at risk of atherothrombosis, living alone was common and associated with an increased risk of mortality and CV death among middle-aged participants. Individuals who live alone may have a less favorable course than all but the most elderly individuals following development of CV disease, and may be an additional risk group on which to focus efforts to improve prognosis.
Keywords: Incidence, Prognosis, Atherosclerosis, Social Support, Employment, Tomography, X-Ray Computed, Vascular Diseases, Cardiovascular Diseases, Risk Factors, Loneliness
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