Abstract:
RATIONALE:Higher social integration is associated with lower cardiovascular mortality; however, whether it is associated with incident coronary heart disease (CHD), especially in women, and whether associations differ by case fatality are unclear. OBJECTIVES:This study sought to examine the associations between social integration and risk of incident CHD in a large female prospective cohort. METHODS AND RESULTS:Seventy-six thousand three hundred and sixty-two women in the Nurses' Health Study, free of CHD and stroke at baseline (1992), were followed until 2014. Social integration was assessed by a simplified Berkman-Syme Social Network Index every 4 years. End points included nonfatal myocardial infarction and fatal CHD. Two thousand three hundred and seventy-two incident CHD events occurred throughout follow-up. Adjusting for demographic, health/medical risk factors, and depressive symptoms, being socially integrated was significantly associated with lower CHD risk, particularly fatal CHD. The most socially integrated women had a hazard ratio of 0.55 (95% confidence interval, 0.41-0.73) of developing fatal CHD compared with those least socially integrated (P for trend <0.0001). When additionally adjusting for lifestyle behaviors, findings for fatal CHD were maintained but attenuated (P for trend =0.02), whereas the significant associations no longer remained for nonfatal myocardial infarction. The inverse associations between social integration and nonfatal myocardial infarction risk were largely explained by health-promoting behaviors, particularly through differences in cigarette smoking; however, the association with fatal CHD risk remained after accounting for these behaviors and, thus, may involve more direct biological mechanisms. CONCLUSIONS:Social integration is inversely associated with CHD incidence in women, but is largely explained by lifestyle/behavioral pathways.
journal_name
Circ Resjournal_title
Circulation researchauthors
Chang SC,Glymour M,Cornelis M,Walter S,Rimm EB,Tchetgen Tchetgen E,Kawachi I,Kubzansky LDdoi
10.1161/CIRCRESAHA.116.309443subject
Has Abstractpub_date
2017-06-09 00:00:00pages
1927-1937issue
12eissn
0009-7330issn
1524-4571pii
CIRCRESAHA.116.309443journal_volume
120pub_type
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