title: Social network, social support, and risk of incident stroke: Atherosclerosis Risk in Communities study.
abstract: OBJECTIVE
  Having a small social network and lack of social support have been associated with incident coronary heart disease; however, epidemiological evidence for incident stroke is limited. We assessed the longitudinal association of a small social network and lack of social support with risk of incident stroke and evaluated whether the association was partly mediated by vital exhaustion and inflammation.
  
  
  METHODS
  The Atherosclerosis Risk in Communities study measured social network and social support in 13 686 men and women (mean, 57 years; 56% women; 24% black; 76% white) without a history of stroke. Social network was assessed by the 10-item Lubben Social Network Scale and social support by a 16-item Interpersonal Support Evaluation List-Short Form.
  
  
  RESULTS
  During a median follow-up of 18.6 years, 905 incident strokes occurred. Relative to participants with a large social network, those with a small social network had a higher risk of stroke (hazard ratio [95% confidence interval], 1.44 [1.02-2.04]) after adjustment for demographics, socioeconomic variables, marital status, behavioral risk factors, and major stroke risk factors. Vital exhaustion, but not inflammation, partly mediated the association between a small social network and incident stroke. Social support was unrelated to incident stroke.
  
  
  CONCLUSIONS
  In this sample of US community-dwelling men and women, having a small social network was associated with excess risk of incident stroke. As with other cardiovascular conditions, having a small social network may be associated with a modestly increased risk of incident stroke.
authors.affiliation: From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.). mnagayoshi@nagasaki-u.ac.jp.
authors.forename: Mako
authors.initials: M
authors.lastname: Nagayoshi
authors.affiliation: From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.).
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson-Rose
authors.affiliation: From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.).
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.affiliation: From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.).
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.affiliation: From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.).
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rose
authors.affiliation: From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.).
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012944:Social Support; D020521:Stroke / Q000453:epidemiology* / Q000523:psychology*
keywords: epidemiology; inflammation; social support; stroke