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Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women's Health Initiative Observational Study

Freeborne, Nancy PA-C, MPH, DrPH1; Simmens, Samuel J. PhD2; Manson, JoAnn E. MD, DrPH3; Howard, Barbara V. PhD4; Cené, Crystal W. MD, MPH5; Allison, Matthew A. MD, MPH6; Corbie-Smith, Giselle MD, MSc7; Bell, Christina L. MD8; Denburg, Natalie L. PhD9; Martin, Lisa Warsinger MD10

doi: 10.1097/GME.0000000000001297
Original Articles

Objective: Previous studies have shown social support to be inversely associated with cardiovascular disease (CVD) in men, whereas fewer studies have assessed the relationship in women. The purpose of this study was to evaluate the relationship between perceived social support and cardiovascular outcomes among postmenopausal women enrolled in the Women's Health Initiative Observational Study.

Methods: We examined the relationships between perceived social support and (1) incident coronary heart disease (CHD), (2) total CVD, and (3) all-cause mortality. Participants were Women's Health Initiative Observational Study women, ages 50 to 79 years, enrolled between 1993 and 1998 and followed for up to 10.8 years. Social support was ascertained at baseline via nine questions measuring the following functional support components: emotional/informational, tangible, positive social interaction, and affectionate support.

Results: Among women with prior CVD (n = 17,351) and no prior CVD (n = 73,421), unadjusted hazard ratios ranged from 0.83 to 0.93 per standard deviation increment of social support. Adjustment for potential confounders, such as smoking and physical activity levels, eliminated the statistical significance of the associations with CHD and CVD. However, for all-cause mortality and among women free of baseline CVD, the association was modest but remained statistically significant after this adjustment (hazard ratio = 0.95 [95% confidence interval, 0.91-0.98]). No statistically significant association was observed among women with a history of CVD.

Conclusions: After controlling for potential confounding variables, higher perceived social support is not associated with incident CHD or CVD. However, among women free of CVD at baseline, perceived social support is associated with a slightly lower risk of all-cause mortality.

1Department of Health Administration and Policy, George Mason University, Fairfax, VA

2Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC

3Division of Preventive Medicine Brigham and Women's Hospital, Professor of Medicine, Harvard Medical School, Boston, MA

4Senior Scientist, Medstar Health Research Institute, Washington, DC

5Department of Medicine, Division of General Internal Medicine, University of North Carolina, Chapel Hill, NC

6Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA

7Department of Social Medicine, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC

8University of Hawaii, Honolulu, HI

9Department of Neurology, University of Iowa, Iowa City, IA

10Division of Cardiology, School of Medicine and Health Sciences, George Washington University, Washington, DC.

Address correspondence to: Nancy Freeborne, PA-C, MPH, DrPH, George Mason University, Department of Health Administration and Policy, 4400 University Drive, MS 1J3 Peterson Hall , 4400D Fairfax, Virginia 22030. E-mail:

Received 2 August, 2018

Revised 12 November, 2018

Accepted 12 November, 2018

Funding/support: The Women's Health Initiative program was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.

Financial disclosures/conflicts of interest: None reported.

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© 2019 by The North American Menopause Society.