Table 4.

Studies of social networks and social supports and coronary heart disease. References in table are given on BMJ website

Author, year, countryTotal sample (% women)Age at entryExposureFollow up (years)No of eventsType of eventsAdjustmentsRelative risk*Summary
Prospective aetiological studies
Medalie 1976w49 Israel10 000 (0)>40Perceived love and support from spouse5300AnginaAge, blood pressure, cholesterol, diabetes, ECG abnormalities1.8*+
House 1982w50 USA2754 (52)35-69Social relationships and activities11114Fatal CHDAge, baseline CHD, smoking, forced expiratory volume at 1 secondNot stated+
Berkman 1983w51 USA4725 (53)30-69Social network index9120Fatal CHDAge2.13*++
Reed 1983w52 USA4653 (0)52-71Social network score6218Fatal CHD + non-fatalAge, blood pressure, cholesterol, glucose, uric acid, forced vital capacity, body mass index, exercise, alcohol, complex carbohydrateSocial network associated with CHD prevalence, but not incidence0
Kaplan 1988w53 Finland1330139-59Social network index5223Fatal CHDAge, smoking, blood pressure, cholesterol, prevalent illness, urban/ rural residence1.34 for men but not women0
Vogt 1992w54 USA2603 (54)18-75+Network scope, network frequency, and network size15not statedFatal CHD + non-fatal CHDAge, sex, SES, smoking and subjective health status at baseline1.5* for effect of network scope on CHD incidence; all 3 measures predicted survival in those with CHD+
Orth-Gomer 1993w55 Sweden736 (0)50Emotional support from close people and support from extended network (social integration)625Fatal CHD + non-fatal CHDAge, cholesterol treatment of hypertension, diabetes, body mass index< smoking, physical activity3.8* for social integration 3.1 for emotional support++
Kawachi 1996w56 USA36 624 (0)42-77Social network index4403Fatal CHD + non-fatal MIAge, time period, smoking, blood pressure, cholesterol, diabetes, angina, body mass index, family history, alcohol, exercise1.14. Some evidence for association with fatal CHD (particularly non-sudden cardiac death) rather than non-fatal MI0
Prognostic studies
Chandra 1983w57 USA1401Not statedMarital status10Not statedAll cause mortalityAge, race, smoking, severity of MI, medical care factorsMarried men and women had better in hospital and 10 year survival+
Ruberman 1984w58 USA2320 (0) patients with MI30-69Social support, life stress3128All cause mortality, sudden cardiac deathAge, myocardial function, ventricular arrhythmia, smoking4.5* for the effect of social isolation + high life stress on all cause mortality; 5.62 for sudden cardiac death++
Wiklund 1988w59 Sweden201(0) patients with first MI32-60Social support, depression and other psychosocial factors8.385All cause mortality + recurrent non-fatal MIHypertension, smoking, anginaBeing single increased risk of death+
Case 1992w60 USA1234 (38) participants in diltiazem post-MI trial25-75Living alone, disrupted marriage2226Fatal CHD + recurrent non-fatal MINew York Heart Assocation functional class, ejection fraction, education, no blockers, ventricular premature complexes, prior infarction1.54* for effect of living alone. No effect of marital disruption+
Hedblad 199261 Sweden98 (0) men with ischaemic 24 hour ECG68Social support and social network517Fatal CHD + non-fatal MIAge, smoking, blood pressure, cholesterol, alcohol, exercise, body mass index, triglycerides5.6* and 4.1* for low informational support and low emotional support respectively++
Williams 1992w62 USA1368 (18) patients with angiographicdis ease52 (median)Structural social support (marital status) and function social support9249All cause mortalityAge, ejection fraction, non-invasive myocardial damage index, conduction disturbance, pain/ ischaemic index, mitral regurgitation, number of diseased vessels, % stenosis of left main stem and left anterior descending artery3.34* for effect of unmarried patients without confidant++
Berkman 1992w63 USA194 (48) patients with acute MI65-85+Emotional support0.576All cause mortalityAge, sex, Killip class, ejection fraction, reinfarction, comorbidity, functional disability, previous MI, ventricular tachycardia2.9* for lack of emotional support+
Gorkin 1993w64 USA1322 (17) patients with previous MI + ventricular premature complexes60.8 (SD 9.9)Social support0.8Not statedAll cause mortalityEjection fraction, arrhythmia rates, CHD risk factors,1.46* for 1 point decrease in social support+
Jenkinson 1993w19 UK1376 (22) 7 days after MI25-84Social isolation, life stress, depression, type A3247All cause mortalityAge, previous MI, hospital complications, diabetes, hypertension, car ownership, sex1.33 for social support; no effect of type A or depression0
Friedman 1995w65 USA369 (15) patients after acute MI with ventricular arrhythmias in the CAST63 (SD 9)Social support, life events, depression, anxiety, type A, anger120All cause mortalityPhysiological severity, demographic and other psychosocial factorsNot stated+
  • CHD=coronary heart disease; MI=myocardial infarction; CAST=cardiac arrhythmia suppression trial.

  • * P<0.05.

  • †0=no associationthat is, relative risk not significantly different from unity;

  • +=moderate association (relative risk >1≤2.0);

  • ++=strong association (relative risk >2.0).