**5.4 Social support**

Frequent seeing friends and relatives in a structural manner were modestly associated with greater adherence in 17,113 patients with CVD or CVD risk factors [89]. In hypertensive patients, structural social support improved adherence in two prior meta-analyses [90, 91]. In patients with severe mental diseases (e.g. schizophrenia and bipolar disorder), perceived social support improved adherence to CVD medication. There was a 4.2% increase in medication adherence for each 1% increase in social support (OR1.04, 95% CI 1.02–1.07, *P* = 0.002) [92]. In an HF setting, a prospective cohort study in Taiwan showed an intimate relationship with a spouse or caregiver was associated with a lower risk of 18-month all-cause readmission and cardiac readmission. The intimate partners will likely enhance HF patients' profound physical and psychological well-being [93]. In a Japanese study, poor adherence to medication in super-aged patients with HF is associated with poor clinical outcomes. Multivariable analysis revealed that not receiving assisted living at least once a week was independently associated with hospitalization, mainly due to poor medication adherence. The analysis also revealed that assisted living was particularly effective for patients affected by dementia [76].

Social support can significantly facilitate medication adherence in CVD, especially in frail populations such as the elderly and comorbid patients.
