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Lack of Social Support in the Etiology and the Prognosis of Coronary Heart Disease: A Systematic Review and Meta-Analysis

Barth, Jürgen PhD; Schneider, Sarah BS; von Känel, Roland MD

doi: 10.1097/PSY.0b013e3181d01611
Review Articles

Objective: To conduct a systematic review and meta-analysis on the relevance of low social support for the development and course of coronary heart disease (CHD).

Methods: Three electronic databases were searched (MEDLINE, PsycINFO/PSYNDEX, and Web of Science 2007/03). More than 1700 papers were screened in a first step. We included prospective studies assessing the impact of social support in either an initially healthy study population (etiologic studies) or in a study population with preexisting CHD (prognostic studies).

Outcomes: Myocardial infarction in etiologic studies; cardiovascular mortality and all-cause mortality in prognostic studies. Effects were reported as relative risk (RR) or hazard ratio (HR).

Results: There is some evidence for an impact of low functional social support on the prevalence of CHD in etiologic studies (RR, range, 1.00–2.23). In contrast, there is no evidence of an impact of low structural social support on the prevalence of myocardial infarction in healthy populations (RR, range, 1.01–1.2). In prognostic studies, results consistently show that low functional support negatively affects cardiac and all-cause mortality (pooled RR, range, 1.59–1.71). These results were also confirmed in analyses adjusted for other risk factors for disease progression (pooled HR, 1.59). It remains unclear whether low structural social support increases mortality in patients with CHD (pooled RR, between 1.56; pooled HR, 1.12, NS).

Conclusions: Because the perception of social support seems important for CHD prognosis, monitoring of functional social support is indicated in patients with CHD, and interventions to increase the perception of positive social resources are warranted.

AMI = acute myocardial infarction; BDI = Beck Depression Inventory; CABG = coronary artery bypass grafting; CHD = coronary heart disease; CI = confidence interval; CPK = creatinine phosphokinase; DBP = diastolic blood pressure; f = females; LVEF = left ventricular ejection fraction; m = males; MI = myocardial infarction; NYHA = New York Heart Association; SBP = systolic blood pressure; SD = standard deviation; SES = socioeconomic status; yrs = years.

Supplemental digital content is available in the article.

From the Institute of Social and Preventive Medicine (J.B., S.S.), Division of Social and Behavioral Health Research, University of Bern, Bern, Switzerland; Department of General Internal Medicine, Division of Psychosomatic Medicine, and Cardiovascular Prevention and Rehabilitation (S.S., R.v.K.), Bern University Hospital, Inselspital, and University of Bern, Bern, Switzerland.

Disclosure: Dr. von Känel previously received funding from Pfizer AG. and Wyeth Pharmaceuticals AG, both in Switzerland. The remaining authors have no potential conflict of interest.

Address correspondence and reprint requests to Jürgen Barth, PhD, Institute of Social and Preventive Medicine (ISPM), University of Bern, Niesenweg 6, CH-3012 Bern, Switzerland. E-mail:

Received for publication July 7, 2008, revision received May 18, 2009.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site

Copyright © 2010 by American Psychosomatic Society
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