Abstract Title Exploring the Association Between Loneliness, Depression and Heart Disease Risk in a Free Medical Clinic

Background Depression and loneliness have each been linked to cardiovascular disease (CVD), but few studies have examined their combined impact. A 2022 AHA statement identified loneliness as an independent CVD risk factor, while depression is tied to elevated 10-year and lifetime ASCVD risk, commonly assessed with the ACC ASCVD calculator and PHQ-9. This study investigated how UCLA Loneliness Scale and PHQ-9 scores relate to ASCVD risk in adults at a free clinic in Upstate South Carolina.

Methods Thirty-one English-speaking patients ages 20–79 with a lipid panel drawn in the past year were recruited. Participants completed the PHQ-9, UCLA Loneliness Scale, and a brief health and demographic survey before or after their visit. A free pulse oximeter was offered as an incentive. Depression and loneliness scores were calculated based on the respective scoring guides. PHQ9 and UCLA loneliness scores were calculated per standard guides. Ten-year and lifetime ASCVD risks were computed using the ACC ASCVD calculator. Data were de-identified and analyzed in Excel for correlations, scatter plots, and multiple linear regressions, cross-verified using two online calculators.

Results Data from 30 participants were analyzed after excluding one outlier. Multiple linear regression revealed a moderate, significant collective effect of PHQ-9 and UCLA scores on total cholesterol (R=0.51, p=0.017). Higher PHQ-9 scores were associated with lower total cholesterol, while higher UCLA scores correlated with higher total cholesterol. Stratification by statin use (n=13) and non-use (n=17) weakened these associations (p=0.28; p=0.24). No significant relationships emerged between PHQ-9, UCLA scores, and LDL levels overall (p=0.27), though subgroup trends suggested higher PHQ-9 scores linked to lower LDL and higher UCLA scores to higher LDL in statin users (p=0.057). Associations with HDL were weak and non-significant. A strong correlation was found between PHQ-9 and UCLA scores (R=0.66, p<0.001). However, relationships with 10-year or lifetime ASCVD risk were weak and non-significant on both multiple and simple regressions.

Conclusion No significant associations were observed between ASCVD risk and PHQ-9 or UCLA scores, likely due to the small sample size. Larger studies are needed to clarify these relationships. Importantly, we identified a significant link between depression and loneliness scores and total cholesterol. While these psychosocial factors are closely related, our findings suggest they may pose distinct challenges to cardiovascular health and are not interchangeable predictors of cholesterol or ASCVD risk.