Living alone and cardiovascular disease outcomes

Gandhi, S. et al. (2019) Living alone and cardiovascular disease outcomes. Heart, 105(14), pp. 1087-1095. (doi: 10.1136/heartjnl-2018-313844) (PMID:30792241)

Abstract

Objective: To evaluate cardiovascular (CV) outcomes in outpatients with coronary artery disease (CAD) living alone compared with those living with others. Methods: The prospeCtive observational LongitudinAl RegIstry oF patients with stable coronarY artery disease (CLARIFY) included outpatients with stable CAD. CLARIFY enrolled participants in 45 countries from November 2009 to July 2010, with 5 years of follow-up. Living arrangement was documented at baseline. The primary outcome was a composite of major adverse cardiovascular events (MACEs) defined as CV death, myocardial infarction (MI) and stroke. Results: Among 32 367 patients, 3648 patients were living alone (11.3%). After multivariate adjustment, there were no residual differences in MACE among patients living alone compared with those living with others (HR 1.04, 95% CI 0.92 to 1.18, p=0.52); however, there was significant heterogeneity in the exposure effect by sex (P<0.01). Specifically, men living alone were at higher risk for MACE (HR 1.17, 95% CI 1.002 to 1.36, p=0.047) as opposed to women living alone (HR 0.82, 95% CI 0.65 to 1.04, p=0.1), predominantly driven by a heterogeneous effect by sex on MI (P=0.006). There was no effect modification for MACE by age group (P=0.3), although potential varying effects by age for MI (P=0.046) and stroke (P=0.05). Conclusions: Living alone was not associated with an independent increase in MACE, although significant sex-based differences were apparent. Men living alone may have a worse prognosis from CV disease than women; further analyses are needed to elucidate the mechanisms underlying this difference. Tiral Registration Number: ISRCTN43070564.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mcskimming, Mrs Paula and Greenlaw, Miss Nicola and Ford, Professor Ian
• Authors: Gandhi, S., Goodman, S. G., Greenlaw, N., Ford, I., Mcskimming, P., Ferrari, R., Jang, Y., Alcocer-Gamba, M. A., Fox, K., Tardif, J.-C., Tendera, M., Dorian, P., Steg, G., and Udell, J. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Heart
• Publisher: BMJ Publishing Group
• ISSN: 1355-6037
• ISSN (Online): 1468-201X
• Published Online: 21 February 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Heart 105(14): 1087-1095
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher