Effects of Social Support on Cardiovascular Outcomes and Mortality

Postmenopausal women were recruited from the Women’s Health Initiative Observational Study to analyze the relationship between perceived social support and CVD or all-cause mortality.

Among postmenopausal women, higher perceived social support is not associated with cardiovascular events such as incident coronary heart disease (CHD), cardiovascular disease (CVD), and all-cause mortality, according to a study published in Menopause.

Researchers analyzed a cohort of postmenopausal women from the Women’s Health Initiative Observational Study to analyze the relationship between perceived social support and CVD or all-cause mortality. Women aged 50 to 79 years (N=92,715) were recruited, and baseline data was collected at the time of enrollment. Participants self-reported their medical and psychological histories.

Perception of functional support was determined by the use of 9 questions chosen from the 19-item Medical Outcomes Study Social Support Survey (MOS-SSS), a tool that assesses 5 dimensions of support: emotional, informational, tangible, positive social interaction, and affectionate support. A summary score of questions ranged from 9 to 45, with the higher score corresponding to higher social support.Participants completed self-reported questionnaires for health behaviors (eg, smoking and alcohol intake) and dietary measures (percentage intake of fat, sugar, fruits, and vegetables). Physical measurements including body mass index (BMI) and waist and hip circumferences were obtained.

The primary outcome measures of the study were as follows: 1) incident CHD, defined as myocardial infarction (MI) and/or death from CHD; 2) total CVD, defined as MI, stroke, or death caused by definite or possible CHD, cerebrovascular disease, or other CVD; and 3) all-cause mortality including CVD mortality, cancer mortality, and non-CVD, noncancer mortality. 

During 10.8 years of follow-up, the researchers identified 2060 cases of incident CHD (1200 without prior CVD and 850 with prior CVD), 4440 cases of total CVD (2730 without prior CVD and 1710 with prior CVD), and 6029 cases of all-cause mortality 6029 (4030 without prior CVD and 1999 with prior CVD). Among women without prior CVD (n=73,421), the unadjusted hazard ratio (HR) for incident CHD was 0.92 (95% CI, 0.87-0.97), the HR for total CVD was 0.86 (95% CI,0.83-0.89), and the HR for overall mortality was 0.83 (95% CI, 0.81-0.86). When adjusted for potential confounders, the HRs for incident CHD and total CVD were 0.99 (95% CI, 0.93-1.06) and 0.96 (95% CI, 0.92-1.00), respectively. For all-cause mortality, the relationship attenuated to 0.95 (CI, 0.91-0.98), but remained statistically significant.

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Among women with prior CVD, the unadjusted HR for incident CHD was 0.93 (95% CI,0.88-1.00), the unadjusted HR for total CVD was 0.91 (95% CI, 0.87-0.95), and the unadjusted HR for all-cause mortality was 0.88 (95% CI, 0.85-0.92). When adjusted for confounders, the HR for incident CHD was 1.04 (95% CI, 0.97-1.12),the HR for total CVD was 1.0 (95% CI, 0.95-1.06), and the HR for all-cause mortality was 1.02 (95% CI, 0.97- 1.07).

“The major finding of our current study is that although perceived social support may be associated with fewer cardiovascular outcomes and decreased all-cause mortality, after controlling for potential confounders, these associations either become much smaller in magnitude or disappear,” the authors reported. “Our conclusion that perceived social support, a type of functional support,may be mildly inversely associated with mortality is important in that it suggests that this is a trend that needs further clarification and investigation.”


Freeborne N, Simmens SJ, Manson JE, et al. Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women’s Health Initiative Observational Study [published online February 19, 2019]. Menopause. doi:10.1097/GME.0000000000001297

This article originally appeared on Clinical Advisor