Abstract P553: The Association of Social Engagement With Cardiovascular Disease Risk Depends on the Risk Horizon: Comparing 10-year, 30-year and Lifetime Risk Estimates

Abstract

Introduction: Social engagement, or the extent to which people enact social ties in real life, is inversely associated with survival. However, less is known about how persons with low vs. high levels of social engagement differ across intermediate health pathways such as cardiovascular disease (CVD) risk. CVD risk comparisons that examine both short and long-term risk are particularly important because age is heavily weighted in short term CVD risk estimates whereas it is absent from lifetime risk estimates. Comparing across CVD risk epochs (10-year, 30-year and lifetime) more clearly partitions the influence of nonmodifiable (age) versus modifiable (blood pressure; lipids, etc.) disease risk elements with respect to social relationship resources. Hypothesis: Are risk differences for low vs. high social engagement consistent across three CVD risk definitions? Methods: Data are from adults free of baseline CVD who participated in in the Third National Health and Nutrition Examination Survey. Six activities comprised the social engagement score: talking on the phone with family, friends or neighbors; getting together with friends or relatives; visiting neighbors; attending church or religious services; belonging to a club or group; attendance at club or group activities. Participation was scored as present/absent; the 0 and 1 categories were combined. CVD risk was assessed using 1) the pooled cohort equations for 10-year risk (ages 40-79; N = 7195); 2) Framingham 30-year hard CVD risk (ages 20-59; N = 10,626); and 3) lifetime risk using established modifiable risk factors but excluding age (ages 20-79; N = 19,320). As per previous literature the latter was collapsed into low (< 39%) and high (>= 39%) lifetime risk. Results: Among the youngest age group common to all three risk estimates (40-49 years old) the 10 year risk difference was 2% across the lowest (0/1) versus highest (6) social engagement scores (4.3% vs. 2.3%, respectively), 6.6% for 30-year hard CVD risk (21.3% vs. 14.7%, respectively) and 19.7% (79.8% vs. 60.1%, respectively) for high lifetime risk. Among younger age groups (20-29 years) the social engagement score risk difference was very small for 30-year risk (0.5%; 3.3% vs. 2.8%) but was large (15.9%) for lifetime risk (60.7% vs.44.8%). A large social engagement score difference for lifetime CVD risk (26.3%) was also observed for persons aged 30-39 years (81.2% vs. 54.9%). In contrast, small ten-year (2.6%) and lifetime risk (2.9%) differences across low vs. high social engagement were observed among persons aged 70-79. Conclusions: CVD risk differences across high and low social engagement are smaller when using age-dependent risk estimates but are substantially larger when comparing lifetime risk, which is not age-dependent. Low social engagement is a marker of substantial modifiable lifetime CVD risk for persons under age 50.