Related Experiment Video
Updated: Jan 28, 2026
In Silico Clinical Trials for Cardiovascular Disease
Published on: May 27, 2022
Living alone and cardiovascular disease outcomes
Sumeet Gandhi1, Shaun G Goodman1, Nicola Greenlaw2
1Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Insights
Living alone does not increase cardiovascular risk for all patients with coronary artery disease. However, men living alone face a higher risk of major adverse cardiovascular events compared to women living alone.
Area of Science:
- Cardiology
- Public Health
- Social Determinants of Health
Background:
- Coronary artery disease (CAD) affects millions globally.
- Living arrangements can influence health outcomes.
- The impact of living alone on cardiovascular disease (CVD) prognosis requires further investigation.
Purpose of the Study:
- To assess the association between living alone and cardiovascular outcomes in patients with stable coronary artery disease (CAD).
- To identify potential differences in risk based on demographic factors such as sex and age.
Main Methods:
- Utilized data from the prospective observational LongitudinAl RegIstry oF patients with stable coronarY artery disease (CLARIFY) registry.
- Included 32,367 outpatients with stable CAD across 45 countries.
- Followed patients for 5 years, documenting living arrangements and major adverse cardiovascular events (MACE), including CV death, myocardial infarction (MI), and stroke.
Main Results:
- No significant difference in MACE was observed between patients living alone (11.3%) and those living with others after multivariate adjustment.
- Significant interaction by sex was found: men living alone had a higher risk of MACE (HR 1.17), while women living alone did not show an increased risk (HR 0.82).
- This sex difference was primarily driven by myocardial infarction risk, with potential age-related variations for MI and stroke.
Conclusions:
- Living alone is not an independent predictor of increased MACE in CAD patients.
- Significant sex-based disparities exist, with men living alone potentially experiencing worse cardiovascular disease prognosis.
- Further research is warranted to understand the underlying mechanisms for these sex differences.
Objective:
To evaluate cardiovascular (CV) outcomes in outpatients with coronary artery disease (CAD) living alone compared with those living with others.
Methods:
The prospeCtive observational LongitudinAl RegIstry oF patients with stable coronarY artery disease (CLARIFY) included outpatients with stable CAD. CLARIFY enrolled participants in 45 countries from November 2009 to July 2010, with 5 years of follow-up. Living arrangement was documented at baseline. The primary outcome was a composite of major adverse cardiovascular events (MACEs) defined as CV death, myocardial infarction (MI) and stroke.
Results:
Among 32 367 patients, 3648 patients were living alone (11.3%). After multivariate adjustment, there were no residual differences in MACE among patients living alone compared with those living with others (HR 1.04, 95% CI 0.92 to 1.18, p=0.52); however, there was significant heterogeneity in the exposure effect by sex (Pinteraction<0.01). Specifically, men living alone were at higher risk for MACE (HR 1.17, 95% CI 1.002 to 1.36, p=0.047) as opposed to women living alone (HR 0.82, 95% CI 0.65 to 1.04, p=0.1), predominantly driven by a heterogeneous effect by sex on MI (Pinteraction=0.006). There was no effect modification for MACE by age group (Pinteraction=0.3), although potential varying effects by age for MI (Pinteraction=0.046) and stroke (Pinteraction=0.05).
Conclusions:
Living alone was not associated with an independent increase in MACE, although significant sex-based differences were apparent. Men living alone may have a worse prognosis from CV disease than women; further analyses are needed to elucidate the mechanisms underlying this difference.
Trial Registration Number:
ISRCTN43070564.
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