A recent study reveals that chronic loneliness over an extended period can significantly elevate the risk of experiencing a stroke.

The increased stroke risk associated with loneliness can be attributed to three main pathways: physiological, behavioral, and psychosocial.

Loneliness can stem from a variety of causes, with both internal and external factors contributing to its emergence.

Consulting with a healthcare provider may offer strategies to manage and alleviate feelings of loneliness.

According to new research, individuals who identify as experiencing prolonged loneliness face a higher likelihood of having a stroke.

The study found that participants expressing loneliness during both interviews conducted four years apart were at a 56% increased risk of stroke.

This research brings a novel perspective by measuring loneliness on two occasions, addressing chronic loneliness' effects. Previous studies typically assessed loneliness at a single point in time, missing the long-term impact.

Data for the research was sourced from the Health and Retirement Study, covering the period from 2006 to 2018. Only participants with two recorded loneliness assessments were included in the analysis.

The study involved 8,936 participants, all aged 50 or older and without a prior history of stroke. Loneliness levels were assessed using responses from the Revised UCLA Loneliness Scale.

Participants were categorized into four groups:

Consistently high — those with high loneliness scores in both assessments

Consistently low — those with low scores in both assessments

Remitting — individuals with an initial high loneliness score that had dropped in the second assessment

Recent onset — people whose loneliness scores were low initially but rose during the second assessment.

The analysis showed those feeling lonely had a 25% higher chance of stroke compared to individuals who reported no loneliness at the start of the study.

The findings have been published in *The Lancet*’s eClinical Medicine journal.

The connection between loneliness and stroke risk

Yenee Soh, ScD, a research associate at Harvard T.H. Chan School of Public Health in Boston and the study's lead author, elaborated on how loneliness and stroke might be intertwined.

Though the study didn’t aim to define the exact mechanisms, Soh indicated that loneliness potentially increases stroke risk through three pathways: physiological, behavioral, and psychosocial.

Earlier research points to several physiological factors, such as increased inflammation, a dampened immune response, and heightened hypothalamic-pituitary-adrenal (HPA) axis activity, that could be involved.

Jayne Morgan, MD, a cardiologist and executive director of community education at Piedmont Healthcare in Atlanta, GA, who wasn’t involved in the study, additionally mentioned elevated blood pressure from mental stress as a potential risk factor.

“In addition,” Morgan added, “unhealthy behaviors like physical inactivity, overeating, higher consumption of ultra-processed foods, increased alcohol and substance use, failure to adhere to prescribed medications, and poor sleep patterns may also contribute.”

On the psychosocial front, an individual's hindered ability to form and maintain fulfilling relationships may perpetuate long-term interpersonal struggles, ultimately increasing stroke vulnerability, Morgan observed.

“A critical takeaway is that loneliness alone is unlikely to directly cause stroke,” noted Yu-Ming Ni, MD, a cardiologist at MemorialCare Heart and Vascular Institute. “It’s likely a combination of factors. Being lonely can reduce the ability to care for oneself effectively.”

Understanding loneliness vs. isolation

“Loneliness is the distressing emotion of feeling alone,” explained Morgan.

“Interestingly, a person may be isolated yet not feel lonely, while someone surrounded by people might still feel lonely,” she noted, highlighting how loneliness and social isolation are distinct experiences.

“Loneliness often feels like standing on the outskirts, feeling misunderstood or disconnected from others. In contrast, isolation refers to a physical separation from human interaction,” Morgan clarified.

Surprisingly, the age group most susceptible to loneliness is young adults between 18 and 22, who also face heightened risks for social isolation, anxiety, and depression.

The study aligns with recommendations from the US Preventive Services Task Force (USPTF), which urges healthcare providers to consider loneliness, isolation, and depression during patient evaluations.

Morgan suggested, “We may be moving toward a time when physicians literally prescribe social engagement and direct patients to community resources.”

Why loneliness isn’t always problematic

Ni acknowledged that loneliness doesn’t affect everyone negatively. “For some, choosing solitude might empower them, offering a sense of strength and meaning. Many lead highly functional, independent lives without facing stroke risks,” Ni stated.

However, external pressures like racial, socioeconomic, and geographic challenges might force loneliness on others.

Reflecting on potential loneliness interventions, Soh remarked, “It’s uncertain whether behavioral or treatment-based approaches can reduce loneliness. Solving this issue requires focusing not only on individuals but also addressing structural and societal influences.”

Soh advocated for a collective approach, stating, “Beyond individual efforts, combating loneliness necessitates broad societal engagement. Numerous organizations are working to offer tools and resources, which the public may find helpful.”— Yenee Soh, ScD