DENMARK: Lone and Elderly Have Higher Rates of ACS

AARHUS, Denmark (theHeart.org), July 13, 2006: People who live alone have double the risk of acute coronary syndrome compared with those who live with a partner, a new study finds. The problem is particularly acute in the elderly, the Danish researchers say. Dr Kirsten Nielsen (Aarhus Sygehus University Hospital, Copenhagen, Denmark) and colleagues report their findings in the August 2006 issue of the Journal of Epidemiology and Community Health. Nielsen said that although previous work has been done in this field, "this study is the largest study to date; it uses a registry and is prospective." "Cardiologists need to take social factors into account," she says. "They don't want to hear about it, but it is important. People living alone should be assessed more quickly and treated more aggressively." Targeting the old and lonely may be cost effective Using a cohort of 138 290 residents of Aarhus aged 30 to 69 years, Nielsen et al prospectively identified 646 victims of ACS over a two-year period from 2000 to 2002. "We were able to combine prospective case findings based on clinical data and definite diagnostic criteria with the benefits of Danish registers, [which] have a high validity as they are generated from compulsory reporting . . . for each citizen . . . [and] Danish legislation does not require informed consent," they explain. Using this information, they found that poor educational attainment and living on a pension were associated with an increased risk of ACS. But the two strongest predictive factors for the syndrome were age and living alone. Women older than the age of 60 and living by themselves and men over 50 in the same position were twice as likely to have the syndrome as everyone else. Lone women over 60 made up just 5.4% of the population and lone men over 50 just 7.7%, yet they accounted for 34.3% and 62.4% of all deaths from the syndrome within 30 days of diagnosis. Certain risk factors were seen more often in those who lived by themselves, which may help to explain the differences, the authors say. These included smoking, obesity, high cholesterol, fewer visits to the family doctor, and a decreased tendency or ability to call for help in emergency situations. The lowest risks included cohabiting with a partner, a high level of education, and being employed. Interestingly, women divorcees also enjoyed a lower risk of the syndrome. "Being divorced is not equal to living alone," the researchers note, "but other explanatory psychosocial factors may be of importance." "We need to send the message that the elderly and those living alone are often forgotten in our society, and doctors must pay more attention to this," Nielsen commented. "By use of comparatively simple information from a population register, groups with excessively high risk of ACS and high risk of dying from ACS are identifiable. Such groups may be targets for complementary high-risk preventive strategies, which may be cost-effective as they entail only small parts of the residential population." Source Nielsen KM, Faergeman O, Larsen ML, et al. Danish singles have a twofold risk of acute coronary syndrome: data from a cohort of 138,290 persons. J Epidemiol Community Health 2006; 60:721-728. By Lisa Nainggolan