title: Social engagement and the risk of cardiovascular disease mortality: results of a prospective population-based study of older men.
abstract: OBJECTIVE
  To examine the prospective relation of social engagement with cardiovascular disease (CVD) mortality, taking into account behavioral factors (smoking, physical activity, body weight, and alcohol consumption), socioeconomic factors, and presence of comorbidity and disability.
  
  
  METHODS
  A socioeconomically representative cohort of 5925 men aged 52-74 years from 24 British towns was followed up from 1992-2006. A scale from 0-9 was used based on questions reflecting the frequency and extent of social engagement in 1992.
  
  
  RESULTS
  CVD mortality risk decreased with increasing social engagement score-age-adjusted hazard ratio (HR) for those with the highest social engagement score of 8-9 was 0.42 (95% confidence interval [95%CI], 0.32-0.53) compared to those with the lowest scores of 0-3 (p for trend < or = 0.0001). Further adjustment for behavioral factors (smoking, alcohol, physical activity, and body weight), disability, comorbidity, and socioeconomic factors reduced the strength of this association, although strong evidence of an association remained: HR 0.70 (95%CI, 0.53-0.93) for highest versus lowest social engagement scores (p for trend = 0.0004). Although the association appeared somewhat stronger in subjects with preexisting CVD (HR 0.59 for highest vs. lowest social engagement scores) than in those without (HR 0.79), there was no evidence of an interaction between social engagement and preexisting CVD (p = 0.61).
  
  
  CONCLUSIONS
  In our study of older men, social engagement appeared to have a modest protective effect on CVD mortality independent of behavioral factors, socioeconomic conditions, disease, and disability.
authors.affiliation: Department of Primary Care & Population Sciences, University College London, London, UK. s.ramsay@pcps.ucl.ac.uk
authors.forename: Sheena
authors.initials: S
authors.lastname: Ramsay
authors.forename: Shah
authors.initials: S
authors.lastname: Ebrahim
authors.forename: Peter
authors.initials: P
authors.lastname: Whincup
authors.forename: Olia
authors.initials: O
authors.lastname: Papacosta
authors.forename: Richard
authors.initials: R
authors.lastname: Morris
authors.forename: Lucy
authors.initials: L
authors.lastname: Lennon
authors.forename: S G
authors.initials: SG
authors.lastname: Wannamethee
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011593:Psychology, Social; D012307:Risk Factors; D012933:Social Identification; D012944:Social Support; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology