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Social Networks Are Associated With Lower Mortality Rates Among Women With Suspected Coronary Disease: The National Heart, Lung, and Blood Institute-Sponsored Women’s Ischemia Syndrome Evaluation Study

Rutledge, Thomas PhD; Reis, Steven E. MD, FACC; Olson, Marian MS; Owens, Jane PhD; Kelsey, Sheryl F. PhD; Pepine, Carl J. MD, FACC; Mankad, Sunil MD, FACC; Rogers, William J. MD, FACC; Bairey Merz, C Noel MD, FACC; Sopko, George MD; Cornell, Carol E. PhD; Sharaf, Barry MD, FACC; Matthews, Karen A. PhD

doi: 10.1097/01.psy.0000145819.94041.52
Original Articles

Objective: To examine the association between social relationships measured by the Social Network Scale and coronary artery disease (CAD) risk and mortality among a sample of women with suspected CAD.

Methods: Five hundred three women (mean age, 59 years) with suspected CAD warranting clinical investigation completed a diagnostic protocol including psychosocial testing, CAD risk factor assessment, and quantitative coronary angiography. Patients were subsequently followed for a mean of 2.3 years to track all-cause mortality.

Results: Women reporting higher social network scores showed a consistent pattern of reduced coronary artery disease risk, including lower blood glucose levels (r = −0.11; p = .03), lower smoking rates (odds ratio [OR] = 0.81; 95% confidence interval [CI] = 0.71–0.93; p = .002), lower waist-hip ratios (r = −0.18; p < .01), and lower rates of hypertension (OR = 0.90; 95% CI = 0.81–0.99; p = .04) and diabetes (OR = 0.83; 95% CI = 0.73–0.94; p = .004). Based on quantitative angiogram findings, high social network scorers also had less severe CAD (mean angiogram stenosis value, 40.8 vs. 27.2 for low and high scoring social network groups, respectively; p < .001). Finally, mortality rates over follow-up showed a dose-response pattern in relation to quartile scorers on the Social Network Index, with low scorers showing more than twice the death rate of high scorers (relative risk = 2.4; p = .03).

Conclusions: Among a cohort of women with suspected CAD, smaller social circles were associated with increased CAD risk factors and mortality, an effect that appeared to be explained largely by income level. The findings extend previous studies of social network effects on health by highlighting risk among women with suspected CAD, and suggest mechanisms for further study.

CAD = coronary artery disease; WISE = Women’s Ischemia Syndrome Evaluation; SES = socioeconomic status; SNI = Social Network Index; CI = confidence interval; RR = relative risk.

From the University of California, San Diego, San Diego, California (T.R.); the University of Pittsburgh, Pittsburgh, Pennsylvania (S.E.R., M.O., J.O., S.F.K., K.A.M); the University of Florida, Gainesville, Florida (C.J.P.); Allegheny General Hospital, Pittsburgh, Pennsylvania (S.M.); the University of Alabama, Birmingham, Alabama (W.J.R., C.E.C.); Cedars-Sinai Medical Center, Los Angeles, California (C.N.B.M.); the National Heart, Lung, and Blood Institute, Bethesda, Maryland (G.S.); and Rhode Island Hospital, Providence, Rhode Island (B.S.).

Address correspondence and reprint requests to Thomas Rutledge, PhD, Psychology Service 116B, VA San Diego Healthcare System, Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail:

Received for publication April 1, 2004; revision received June 29, 2004.

Supported by contracts from the National Heart, Lung, and Blood Institute, N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164; a GCRC grant M01-RR00425 from the National Center for Research Resources; and grants from the Gustavus and Louis Pfeiffer Research Foundation, the Women’s Guild, Cedars-Sinai Medical Center, the Ladies Hospital Aid Society of Western Pennsylvania, and QMED.

Copyright © 2004 by American Psychosomatic Society
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