Loneliness status transitions and risk of cardiovascular disease among middle-aged and older adults

Background and Aims Loneliness is a risk factor for cardiovascular disease (CVD), and the levels at which individuals experience it can transition over time. However, the impact of increased loneliness or decreased loneliness on later CVD remains unexplored. We aimed to identify the age-specific association between loneliness status transitions and subsequent CVD incidences in middle-aged and older adults. Methods and results Data was extracted from the China Health and Retirement Longitudinal Study (CHARLS) on 8463 adults to evaluate how loneliness status transitions across two data collection points were associated with the subsequent CVD incidence at a five-year follow-up. Loneliness status transitions were divided into four categories: stable low loneliness, decreased loneliness, increased loneliness, and stable high loneliness. Data were analyzed using a Cox-proportional hazards model with age subgroups, accounting for covariates at baseline. During follow-up, the incidence rate of CVD per 1000 person-years was lower for the stable low loneliness group and decreased loneliness group compared to the increased loneliness and stable high loneliness group. Increased loneliness is associated with the highest risk of overall CVD and heart disease (HR 2.44, P<0.001; HR 2.34, P<0.001), while stable high loneliness is associated with the highest risk of stroke among the four loneliness categories (HR 4.29, P<0.05). The age-specific analyses revealed no statistically significant interaction terms of loneliness status transitions and age group. Conclusion Increased loneliness and stable high loneliness are associated with higher CVD risk. In clinical practice, it is important to monitor patients’ loneliness status transitions to reduce CVD incidences.