J Hum Hypertens. 2015 Jul;29(7):417-23.

Social network, presence of cardiovascular events and mortality in hypertensive patients.

 

Menéndez-Villalva C1, Gamarra-Mondelo MT2, Alonso-Fachado A3, Naveira-Castelo A1, Montes-Martínez A4.
  • 1Mariñamansa-A Cuña Health Center, Galician Health Service, Ourense, Spain.
  • 2Pontedeva Health Center, Galician Health Service, Ourense, Spain.
  • 3Carballo Health Center, Galician Health Service, Corunna, Spain.
  • 41] Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain [2] CIBER Epidemiología y Salud Pública (CIBERESP), Spain.

 

Abstract

The aim of this study was to ascertain the relationship between social network and the appearance of mortality (cardiovascular events (CVEs)) in patients with arterial hypertension (AHT). This is a cohort study of 236 patients with a 9-year follow-up. Measurements included age, sex, blood pressure (BP), diabetes, hypercholesterolemia, marital status, social network, social support, stage of family life cycle (FLC), mortality and CVEs. Patients with a low social network registered higher global mortality (hazards ratio (HR) 2.6 (95% confidence interval (CI) 1.3; 5.5)) as did the oldest patients (HR 5.6 (1.9; 16.8)), men (HR 3.5 (95% CI 1.3; 9.3)) and subjects in the last FLC stages (HR 4.3 (95% CI 1.3;14.1)). Patients with low social support registered higher cardiovascular mortality (HR 2.6 (95% CI 1.1; 6.1)) as did the oldest patients (HR 12.4 (95% CI 2.8; 55.2)) and those with diabetes (HR 3.00 (95% CI 1.2; 7.6)). Patients with a low social network registered more CVEs (HR 2.1 (95% CI 1.1; 4.1)) than patients with an adequate network, as did the oldest patients (HR 3.1 (95% CI 1.4; 6.9)), subjects who presented with a higher grade of severity of AHT (HR 2.7 (1.3; 5.5)) and those in the last FLC stages (HR 2.5 (95% CI 1.0; 6.2)). A low social network is associated with mortality and the appearance of CVEs in patients with AHT. Low functional social support is associated with the appearance of cardiovascular mortality.

PMID: 25500900

 

Supplement

The available evidence on the impact of social support on health is limited. Several studies have shown a correlation between the lack of emotional support and worse perceived health in men [i]. Cardiovascular diseases are the first health problem in developed countries, the first cause of mortality and hospitalization, with more than 125,000 deaths and more than 5 million hospital stays per year, assuming a cost of 7,100 million euros per year and absorbing the 7% of health expenditure.

This study therefore sought to ascertain whether low social support might be associated with mortality and the appearance of cardiovascular events in a cohort of hypertensive patients controlled over a period of 9 years.

 

fig1-1

Figure 1. Free time for cardiovascular events according to the confidential social support

 

The mean social network consisted of 2.7 contacts per patient, with 22% of patients presenting with low functional support. These patients registered higher cardiovascular mortality [HR 2.6 (95% CI 1.1; 6.1)] as did the oldest patients [HR 12.4 (95% CI 2.8; 55.2)] and those with diabetes [HR 3.00 (95% CI 1.2; 7.6)]. Patients with a low social network registered more cardiovascular events [HR 2.1 (95% CI 1.1; 4.1)] than patients with an adequate network, as did the oldest patients [HR 3.1 (95% CI 1.4; 6.9)], subjects who presented with a higher grade of severity of hypertension [HR 2.7 (1.3; 5.5)] and those in the last family life cycle stages [HR 2.5 (95% CI 1.0; 6.2)].

Social support is defined by Gottlieb (2000) as the process of interaction in relationships which improves coping, esteem, belonging and competence through actual or perceived exchanges of physical or psychosocial resources. According to Cobb (1976), functional support is the perception that leads the individual to believe that caregivers, who is loved, esteemed and valued; and belonging to a communications network and mutual obligations. Emotional support, is communication that meets an individual’s emotional or affective needs. Confidential support: Understood as the possibility of having people who you can communicate them problems or situations requiring assistance.

 

cardio 11-fig2 new

Figure 2. Pathophysiological effect between psychosocial stress and cardiovascular disease.
CNS: central nervous system.

 

Just us Dickens et al[ii], there is a high correlation between total functional support and confidential support, while in others studies emotional support is most involved. Some of the differences might be explained by different methods of measurement and specific group characteristics (figure 1).

We observed no association between cardiovascular events and the presence of stressful life events by patients, marital status or family type; a finding similar of the study conducted by Blazer[iii] and Jenkinson[iv]. It could be due to the predominance of nuclear and extended families function that in our study normally work as support group when the individual suffers a stressful event, facilitating a better adaptation to stress and modulating the detrimental effect on health. Normally functioning families have a cardioprotective effect , because there are fewer conflicts and these are the source of family stress related to the increase in inflammatory markers[v]. By contrast, Ruberman[vi] and Interheart study[vii] found a significant association with stressful events; this difference could be explained by different sample sizes, different ethnic variability and different data processing, since in these works, they made a pooled analysis of stressful life events and social isolation that we did not perform. Pathophysiological effect between psychosocial stress and cardiovascular disease shown in figure 2.

 

fig3

Figure 3. Blood Pressure Monitor

 

References:

[I] Ferrando J, Nebot M, Borrell C, Egea L. Apoyo social y estado de salud percibido población no institucionalizada de más de 60 años. Gac Sanit 1996;10:174-182

[ii] Dickens CM, McGowan L, Percival C, Douglas J, Tomenson B, Cotter L, Heagerty A, Creed FH. Lack of a close confidant, but no depression, predicts further cardiac events after IAM. Heart. 2004; 90: 518-22.

[iii] Blazer D. Social support and mortality in a elderly community population. Am J Epidemiol 1982;115: 684-694

[iv] Jenkinson CM, Madeley RJ, Mitchell RA e Turner ID. The influence of psychosocial factors on survival after myocardial infarction. Public Health 1993;107: 305-317

[v] Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med.1999;340:115-26.

[vi] Ruberman W, Weinblatt E, Goldberg J e Chaudhary B. Psychosocial influences on mortality after myocardial infarction. N Engl J Med 1985;311: 552-9.

[vii] Rosengren A, Hawken S, Ôunpuu K, Zubaid M, Almahmeed W, Blackett K, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953-62.

 

 

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