Prevention of Cardiovascular Morbidity and Mortality: Role of Social Relations
Lisa F. Berkman Yale School of Medicine
Kristina Orth-Gomér Karolinska Institute
Social networks and social support have been found, in a number of studies, to predict mortality, especially from cardiovascular disease (CVD). Recently, several investigators have been exploring where along the spectrum of disease social networks and support might have their greatest influence on the disease process. Studies revealing an association between social isolation and increased coronary heart disease (CHD) mortality, for instance, tell us nothing about whether social factors influence: (a) the development of atherosclerosis directly; (b) CHD risk factors, which in turn influence disease processes; (c) the clinical expression of specific CHD endpoints; or (d) survival after the onset of a CHD "event." Although data are still sparse, some important recent studies have shed light on this issue. Most important, because there are now a number of studies indicating an association between mortality and social isolation, or lack of support, it is imperative -- if we are to introduce preventive practices and develop successful interventions -- that we have a more refined understanding of which aspects of social networks and support are related to specific aspects of CVD.
In this chapter, we discuss the development of measures of social networks and support, and we review the evidence linking specific aspects of networks and support to cardiovascular mortality and morbidity. We conclude with the importance of developing clinical trials to test further hypotheses relating to the effects of social networks and support on CVD.