What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Peripheral endothelial dysfunction (n=312). Intervention: Social isolation vs. Lower levels of social isolation. Primary outcome: Peripheral endothelial dysfunction (OR 0.73, 95% CI 0.58-0.92, p=0.006).

What does this research mean for the field?

Social isolation is independently associated with peripheral endothelial dysfunction, particularly in women, suggesting a potential mechanistic link to increased cardiovascular risk. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 18, 2025Mayo Clinic Proceedings6 citationsOpen Access

Social Isolation Is Associated With Peripheral Endothelial Dysfunction

JSJaskanwal Deep Singh SaraInterventional Cardiology NHNegin Mahmoudi HamidabadUniversità Cattolica del Sacro Cuore NRNazanin RajaiThe University of Sydney

Key Result

Higher social network index scores, indicating less social isolation, were independently associated with lower odds of peripheral endothelial dysfunction (adjusted OR 0.73; 95% CI 0.58-0.92; P=0.006).

Study Design

Type

Cross-Sectional (n=312)

Multicenter

Structured PICO

Is social isolation associated with peripheral endothelial dysfunction?

Population

312 patients (mean age 49 years, 68.3% female) referred for assessment of peripheral endothelial dysfunction who completed a social determinants of health survey.

Exposure

Social isolation measured by the social network index (SNI)

Comparator

Different levels of social isolation (none, moderate, severe)

Outcome

Peripheral endothelial dysfunction (PED) defined as a reactive hyperemia index (RHI) of 1.8 or lesssurrogate

Social isolation is independently associated with peripheral endothelial dysfunction, particularly in women, suggesting a mechanistic link to increased cardiovascular risk.

Main Result

Odds Ratio: 0.73 (95% CI 0.58–0.92)

p-value: p=0.006

Abstract

OBJECTIVE: To evaluate the association between social isolation and peripheral endothelial dysfunction (PED) as a marker of early atherosclerosis. METHODS: In this cross-sectional cohort study, patients referred to Mayo Clinic between January 1, 2018, and December 30, 2021, for assessment of PED by reactive hyperemia-peripheral arterial tonometry were included if they had completed a social determinants of health survey (including questions addressing social isolation) within 1 year of enrollment. Peripheral endothelial dysfunction was defined as a reactive hyperemia index (RHI) of 1.8 or less. Social isolation was measured by the social network index (SNI), ranging from 0 (indicating severe isolation) to 4 (indicating least social isolation). The prevalence of PED was compared across individuals with none (SNI=3 or 4), moderate (SNI=2), and severe (SNI=0 or 1) social isolation. Binary logistic regression analysis was used to assess the association between social isolation and PED. RESULTS: A total of 312 patients were included (mean age, 49±15 years; 68.3% female). Peripheral endothelial dysfunction was present in 92 (29.5%) patients. There was a significant correlation between SNI and RHI (r=0.24; P<.001). The RHI was significantly lower in severely isolated individuals compared with moderately or not isolated individuals (1.95 1.51 to 2.39, 2.22 1.71 to 2.73, 2.35 1.82 to 2.88, respectively; P=.02). SNI was inversely associated with PED in univariable and multivariable binary regression analysis adjusted for cardiovascular risk factors (odds ratio, 0.73 95% CI, 0.59 to 0.90; P=.003 and odds ratio, 0.73 95% CI, 0.58 to 0.92; P=.006, respectively). In sex-stratified analysis, severely isolated women were more likely to have lower RHIs (P=.005), whereas there was no significant difference in RHI for men with different levels of social connection (P=.82). CONCLUSION: Social isolation is independently associated with PED, indicating a potential mechanistic link between social isolation and increased cardiovascular risk, particularly for women.

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