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Solitude Can Be Hazardous to Health, Research Finds : Lifestyles: People with heart disease who live alone found more vulnerable to subsequent heart attacks.


At a time when more Americans than ever are living alone, evidence is mounting that isolation can be bad for one's health for reasons that may range from the absence of a ride to a hospital to the lack of some chemical response to human contact.

The latest clues about the health hazards of aloneness are in two studies published today that found people who suffer a heart attack are more likely to die or suffer another attack within six months if they live alone and have no close friends.

Reasons for the pattern are unclear, but previous studies have found higher rates of death in general among the unmarried. In addition, accidents, suicides, psychiatric disorders, even tuberculosis have been found by some to be more common among the socially isolated.

"The data is very strong and suggestive that we need better social contacts," said Dr. Robert B. Case, a New York cardiologist and author of one of the new studies. "It may be very important to maintain these relationships, particularly in today's society."

Nearly 12% of American adults, or 22.6 million people, were living alone at the time of the 1990 census. According to census officials, those figures are believed to represent an all-time high, up from 7%, or 10.8 million adults, in 1970. The rise of the one-person household coincides with advances in knowledge of the health risks of being alone. Some researchers have gone so far as to suggest that social disintegration in the United States is helping to undermine public health.

The new studies, reported in the Journal of the American Medical Assn., focused on people with documented heart disease--people for whom stress is known to have an especially insidious effect, and for whom the benefits of social contacts might be especially apparent.

The first study, by Case and others at St. Luke's-Roosevelt Hospital and Columbia University in New York City, found that heart attack patients living alone were nearly twice as likely as others to suffer another heart attack--and more likely to die of an attack--within six months.

The researchers compared the impact of living alone to that of physical risk factors such as previous heart damage and heart rhythm disturbances. They found that living alone was "a major independent risk factor" comparable to physiological factors.

To Case's surprise, he did not find a similar increase in health risk associated with divorce, separation or the death of a spouse. Half of the people with disrupted marriages in his 1,234-patient study were living with someone else at the time.

"What's particularly significant is the magnitude of the effect," said Nan Case, a clinical psychologist, co-author and Robert Case's wife. "We know that emotions and (social) integration have an effect, but we never knew it could come close to the physiological factors in heart disease."

In the other study, Dr. Redford B. Williams, a professor of psychiatry and psychology at Duke University Medical Center, found that unmarried heart patients without a close personal confidant were significantly less likely than others to survive for five years.

Williams and his colleagues found a similar pattern among the poor in their study of 1,368 men and women: Patients with incomes less than $10,000 a year were much less likely than those with incomes of $40,000 or more to survive for five years.

Like Case, Williams found that the impact of insufficient social contact and inadequate income was independent of the effect of underlying physical factors. The poorer or more isolated patients were not simply sicker to start with and therefore more likely to die, he found.

"That means we don't have here a spurious association," said Williams. ". . . what our findings suggest is that above and beyond the higher risk due to these physical factors, lack of social contact and lack of adequate income put you at an even higher risk."

The link between social relationships and health remains largely unexplained. Researchers speculate that the reasons may include mundane, practical factors as well as more mysterious emotional factors with physical effects.

For example, research has shown that people with social support are more likely to follow medical advice to take medication, alter diets or stop smoking. They are also more likely to have someone around to help them in time of need.

But Williams and others also suggest that people who are alone may experience more stress, without the emotional buffer offered by a companion. Stress can trigger the release of hormones, such as adrenaline, which can have a harmful effect on the heart.

Other studies have suggested that companionship can mitigate the impact of stress on ulcers, hypertension and neurosis in animals, and reduce anxiety and the secretion of certain fatty acids in people in stressful laboratory experiments.

Whatever the mechanisms, researchers urged physicians to pay more attention to their patients' emotional states, and perhaps to recommend, for example, that a companion live with a patient for six months after a heart attack.

"I think there are concrete suggestions that one might make--that a life more replete with social connections and friends and families enriches life and may be medically helpful," said Dr. William Ruberman, a clinical professor at the New York University School of Medicine in the department of environmental medicine.

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