Association between Social Isolation and Left Ventricular Mass



      Social isolation is associated with progression of cardiovascular disease, with the most socially isolated patients being at increased risk. Increased left ventricular mass is a predictor of cardiovascular morbidity and mortality. It is not yet clear whether social isolation is a determinant of increased left ventricular mass.


      We performed a cross-sectional study of Northern Manhattan Study participants who were free of clinical cardiovascular disease and had obtained transthoracic echocardiograms (n=2021) and a baseline questionnaire on social habits. Social isolation was defined as the lack of friendship networks (knowing fewer than 3 people well enough to visit within their homes). Echocardiographic left ventricular mass was indexed to height2.7, analyzed as a continuous variable and compared between exposure groups.


      The prevalence of social isolation was 13.5%. The average left ventricular mass was significantly higher (50.2 gm/m2.7) in those who were, as compared with those who were not (47.6 gm/m2.7), socially isolated (P<.05). Higher prevalence of social isolation was found among those less educated, uninsured, or unemployed. There were no significant race-ethnic differences in the prevalence of social isolation. In multivariate analysis, there was a trend toward an association between social isolation and increased left ventricular mass in the total cohort (P=.09). Among Hispanics, social isolation was significantly associated with greater left ventricular mass. Hispanics who were socially isolated averaged 3.9 gm/ht2.7 higher left ventricular mass compared with those not socially isolated (P=.002). This relationship was not present among non-Hispanic blacks or whites.


      In this urban tri-ethnic cohort, social isolation was prevalent and associated with indices of low socioeconomic status. Hispanics who were socially isolated had a greater risk for increased left ventricular mass.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Levy D.
        • Garrison R.J.
        • Savage D.D.
        • Kannel W.B.
        • Castelli W.P.
        Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study.
        N Engl J Med. 1990; 322: 1561-1566
        • Liao Y.
        • Cooper R.S.
        • McGee D.L.
        • Mensah G.A.
        • Ghali J.K.
        The relative effects of left ventricular hypertrophy, coronary artery disease, and ventricular dysfunction on survival among black adults.
        JAMA. 1995; 273: 1592-1597
        • Koren M.J.
        • Mensah G.A.
        • Blake J.
        • Laragh J.H.
        • Devereux R.B.
        Comparison of left ventricular mass and geometry in black and white patients with essential hypertension.
        Am J Hypertens. 1993; 6: 815-823
        • Rodriguez C.J.
        • Sciacca R.R.
        • Diez-Roux A.V.
        • et al.
        Relation between socioeconomic status, race-ethnicity, and left ventricular mass: the Northern Manhattan Study.
        Hypertension. 2004; 43: 775-779
        • Shumaker S.A.
        • Czajkowski S.M.
        Social Support and Cardiovascular Disease.
        Springer, New York1994
        • Rozanski A.
        • Blumenthal J.A.
        • Davidson K.W.
        • Saab P.G.
        • Kubzansky L.
        The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology.
        J Am Coll Cardiol. 2005; 45: 637-651
        • Knox S.S.
        • Adelman A.
        • Ellison R.C.
        • et al.
        Hostility, social support, and carotid artery atherosclerosis in the National Heart, Lung, and Blood Institute Family Heart Study.
        Am J Cardiol. 2000; 86: 1086-1089
        • Knox S.S.
        Perception of social support and blood pressure in young men.
        Percept Mot Skills. 1993; 77: 132-134
        • Treiber F.A.
        • Baranowski T.
        • Braden D.S.
        • Strong W.B.
        • Levy M.
        • Knox W.
        Social support for exercise: relationship to physical activity in young adults.
        Prev Med. 1991; 20: 737-750
        • Romano P.S.
        • Bloom J.
        • Syme S.L.
        Smoking, social support, and hassles in an urban African-American community.
        Am J Public Health. 1991; 81: 1415-1422
        • Knox S.S.
        • Uvnas-Moberg K.
        Social isolation and cardiovascular disease: an atherosclerotic pathway?.
        Psychoneuroendocrinology. 1998; 23: 877-890
        • Tigges L.M.
        • Browne I.
        • Green G.P.
        Social isolation of the urban poor: race, class, and neighborhood effects on social resources.
        Sociol Q. 2008; 39: 53-57
        • McPherson M.
        • Smith-Lovin L.
        • ME B.
        Social isolation in America.
        Am Sociol Rev. 2006; 71: 353-375
        • Everson S.A.
        • Lynch J.W.
        • Kaplan G.A.
        • Lakka T.A.
        • Sivenius J.
        • Salonen J.T.
        Stress-induced blood pressure reactivity and incident stroke in middle-aged men.
        Stroke. 2001; 32: 1263-1270
        • Lynch J.W.
        • Everson S.A.
        • Kaplan G.A.
        • Salonen R.
        • Salonen J.T.
        Does low socioeconomic status potentiate the effects of heightened cardiovascular responses to stress on the progression of carotid atherosclerosis?.
        Am J Public Health. 1998; 88: 389-394
        • Clark R.
        Self-reported racism and social support predict blood pressure reactivity in blacks.
        Ann Behav Med. 2003; 25: 127-136
        • Glynn L.M.
        • Christenfeld N.
        • Gerin W.
        Gender, social support, and cardiovascular responses to stress.
        Psychosom Med. 1999; 61: 234-242
        • Gump B.B.
        • Matthews K.A.
        • Raikkonen K.
        Modeling relationships among socioeconomic status, hostility, cardiovascular reactivity, and left ventricular mass in African American and white children.
        Health Psychol. 1999; 18: 140-150
        • Rapaport E.
        Pathophysiological basis of ventricular hypertrophy.
        Eur Heart J. 1982; 3: 29-33
        • Post W.S.
        • Larson M.G.
        • Levy D.
        Impact of left ventricular structure on the incidence of hypertension.
        Circulation. 1994; 90: 179-185
        • Boden-Albala B.
        • Sacco R.L.
        Socio-cultural determinants of stroke in a multiethnic community: findings from the Northern Manhattan Stroke Study.
        Ann Epidemiol. 2004;
        • Willey J.Z.
        • Williams O.
        • Boden-Albala B.
        Stroke literacy in Central Harlem: a high-risk stroke population.
        Neurology. 2009; 73: 1950-1956
        • Willey J.Z.
        • Moon Y.P.
        • Paik M.C.
        • Boden-Albala B.
        • Sacco R.L.
        • Elkind M.S.
        Physical activity and risk of ischemic stroke in the Northern Manhattan Study.
        Neurology. 2009; 73: 1774-1779
        • Boden-Albala B.
        • Litwak E.
        • Elkind M.S.
        • Rundek T.
        • Sacco R.L.
        Social isolation and outcomes post stroke.
        Neurology. 2005; 64: 1888-1892
        • Berkman L.F.
        • Syme S.L.
        Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents.
        Am J Epidemiol. 1979; 109: 186-204
        • Boden-Albala B.
        • Sacco R.L.
        Socioeconomic status and stroke mortality: refining the relationship.
        Stroke. 2002; 33: 274-275
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • et al.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Park S.H.
        • Shub C.
        • Nobrega T.P.
        • Bailey K.R.
        • Seward J.B.
        Two-dimensional echocardiographic calculation of left ventricular mass as recommended by the American Society of Echocardiography: correlation with autopsy and M-mode echocardiography.
        J Am Soc Echocardiogr. 1996; 9: 119-128
        • Orth-Gomer K.
        • Rosengren A.
        • Wilhelmsen L.
        Lack of social support and incidence of coronary heart disease in middle-aged Swedish men.
        Psychosom Med. 1993; 55: 37-43
        • Michael Y.L.
        • Colditz G.A.
        • Coakley E.
        • Kawachi I.
        Health behaviors, social networks, and healthy aging: cross-sectional evidence from the Nurses' Health Study.
        Qual Life Res. 1999; 8: 711-722
        • Vogt T.M.
        • Mullooly J.P.
        • Ernst D.
        • Pope C.R.
        • Hollis J.F.
        Social networks as predictors of ischemic heart disease, cancer, stroke and hypertension: incidence, survival and mortality.
        J Clin Epidemiol. 1992; 45: 659-666
        • House J.S.
        • Landis K.R.
        • Umberson D.
        Social relationships and health.
        Science. 1988; 241: 540-545
        • Rosengren A.
        • Wilhelmsen L.
        • Orth-Gomer K.
        Coronary disease in relation to social support and social class in Swedish men.
        Eur Heart J. 2004; 25: 56-63
        • House J.S.
        • Robbins C.
        • Metzner H.L.
        The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community Health Study.
        Am J Epidemiol. 1982; 116: 123-140
        • Brummett B.H.
        • Barefoot J.C.
        • Siegler I.C.
        • et al.
        Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality.
        Psychosom Med. 2001; 63: 267-272
        • Kawachi I.
        • Colditz G.A.
        • Ascherio A.
        • et al.
        A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA.
        J Epidemiol Community Health. 1996; 50: 245-251
        • Broman C.L.
        Social relationships and health-related behavior.
        J Behav Med. 1993; 16: 335-350
        • Hanson B.S.
        • Isacsson S.O.
        • Janzon L.
        • Lindell S.E.
        Social support and quitting smoking for good.
        Addict Behav. 1990; 15: 221-233
        • Wirtz P.H.
        • von Kanel R.
        • Mohiyeddini C.
        • et al.
        Low social support and poor emotional regulation are associated with increased stress hormone reactivity to mental stress in systemic hypertension.
        J Clin Endocrinol Metab. 2006; 91: 3857-3865
        • Kamarck T.W.
        • Manuck S.B.
        • Jennings J.R.
        Social support reduces cardiovascular reactivity to psychological challenge: a laboratory model.
        Psychosom Med. 1990; 52: 42-58
        • Ghiadoni L.
        • Donald A.E.
        • Cropley M.
        • et al.
        Mental stress induces transient endothelial dysfunction in humans.
        Circulation. 2000; 102: 2473-2478
        • Waite L.J.
        Does marriage matter?.
        Demography. 1995; 32: 483-507
        • Uchino B.N.
        • Cacioppo J.T.
        • Kiecolt-Glaser J.K.
        The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health.
        Psychol Bull. 1996; 119: 488-531
        • Sherraden M.S.
        • Barrera R.E.
        Prenatal care experiences and birth weight among Mexican immigrant women.
        J Med Syst. 1996; 20: 329-350
        • Suarez L.
        Pap smear and mammogram screening in Mexican-American women: the effects of acculturation.
        Am J Public Health. 1994; 84: 742-746
        • Abraido-Lanza A.F.
        • Guier C.
        • Revenson T.A.
        Coping and social support resources among Latinas with arthritis.
        Arthritis Care Res. 1996; 9: 501-508
        • Rodriguez C.J.
        • Burg M.M.
        • Meng J.
        • et al.
        Effect of social support on nocturnal blood pressure dipping.
        Psychosom Med. 2008; 70: 7-12