Abstract 9328: Living Alone and Cardiovascular Events in Stable Outpatients at Risk of or with Atherothrombosis: Insight From the REACH Registry
Background: Living alone (LA), a proxy for social support, has been inconsistently linked with CVD.
Methods: Outpatients from 29 countries at risk of, or with, atherothrombosis were enrolled in the REACH registry and followed for 4 years. Event rates for mortality, vascular events (CV death, MI, or stroke), CHF, bleeding, and vascular procedures were examined by living arrangement with sequential risk adjustment for age, gender, CV risk factors, therapy, degree of preexisting atherothrombosis, and sociodemographic factors. Effect modification was tested by age, gender, geography, ethnicity, education, and employment.
Results: Among the 44,617 REACH patients with reported living arrangements, 8,605 (19%) were living alone. LA strongly correlated with 4-year mortality (11.4% vs. 9.3%, crude HR, 1.16 [95% CI 1.08-1.24]; p<0.001), risk of vascular events (12.9% vs. 11.9%, crude HR, 1.27 [1.18-1.37]; p<0.001) along with CV death, hospitalization for CHF, bleeding, and vascular procedures. However, after multivariable adjustment the effect of LA on mortality (adjusted HR 1.17 [0.99-1.25] and risk of vascular events (adjusted HR 1.08 [0.98-1.18]) was attenuated. LA remained associated with increased risks of CHF (HR 1.09 [1.00-1.18]), vascular procedures (HR 1.44 [1.21-1.72]), PCI (HR 1.33 [1.04-1.69]), and limb amputation (HR 3.32 [95% CI 1.89-5.82]). There was effect modification by age and employment status, with an inverse correlation between LA and mortality in those older than 80 years or retired.
Conclusion: In the REACH population, age, current risk factors, and past CV events accounted for most of the association between LA and increased mortality or risk of major vascular events. However, LA was associated with several serious CV events such as risk of CHF, PCI and limb amputation. Elderly retired individuals who live alone may have more favorable prognosis from CVD than others living alone.
- © 2011 by American Heart Association, Inc.