A close friendship takes more than 200 hours, and heart science now counts connection

Key takeaways

• A 2022 American Heart Association scientific statement linked social isolation and loneliness to about a 29% higher risk of heart attack or heart disease death and a 32% higher risk of stroke¹².
• In a CDC survey of nearly 219,000 adults, about 32% said they felt socially isolated at least sometimes, and adults 18 to 34 reported it most⁶.
• Medicare’s yearly wellness visit includes a questionnaire meant to cover loneliness and social isolation, even though federal officials dropped hospital social-needs screening measures and rewrote a related billing code for 2026⁷⁸⁹¹¹.
• A University of Kansas study estimated that going from acquaintance to close friend takes more than 200 hours together, and joking or catching up counted more than working side by side¹²¹³.
• No trial has shown that building connection prevents heart attacks, but the weekly audit in this article can show where your own ties are thin.

In a study published in 2018, Jeffrey Hall, a communication studies professor at the University of Kansas, surveyed 355 adults who had moved to a new place within the past six months¹². He asked each one to think of someone they had met since the move and how that relationship had grown¹².

His results turned friendship into arithmetic. Moving from acquaintance to casual friend took roughly 50 hours. Becoming a real friend took about 90. A close friend took more than 200¹²¹³.

Four years later, the American Heart Association described what happens to people who go without that investment. Its 2022 scientific statement tied social isolation and loneliness to about a 29% higher risk of heart attack or death from heart disease, and a 32% higher risk of stroke¹.

Put those findings side by side and connection starts to look like other prevention habits. It takes regular time. It can be measured. And it shows up in heart research.

Here is what the heart research found, how Medicare asks about connection, why friendship runs on hours, and a weekly audit to track your own.

Heart researchers now treat isolation as a risk

The statement appeared in the Journal of the American Heart Association in August 2022. Its writing group, chaired by Crystal Wiley Cené of UC San Diego Health, reviewed research published through July 2021¹².

It kept two ideas apart. Social isolation means having few in-person contacts. Loneliness is the distress of feeling less connected than you want to be¹². You can have one without the other.

The 29% and 32% figures are relative risks, so they don’t tell you how many extra heart attacks to expect. The statement’s starkest absolute numbers come from people who already had heart disease.

In one study of heart failure, 79 of every 100 people with more social contact and no depression were alive five years later. Among those who were isolated, with or without depression, only 60 to 62 of every 100 were².

Isolated people with heart disease had two to three times the risk of dying over six years². Having three or fewer social contacts a month may raise the chance of another stroke or heart attack by about 40%².

How could loneliness reach your arteries? The statement points to several routes. Isolated and lonely people show higher markers of inflammation and more signs of chronic stress². They are also more likely to smoke, move less, sit more and eat fewer fruits and vegetables¹².

The limits matter, too. These are observational studies, which track people over time without assigning anyone to a group, so they show a link rather than proof of cause. Evidence was strongest for heart disease and stroke, and sparse or mixed for heart failure, dementia and memory problems¹.

Few studies measured isolation and loneliness together, so it’s unclear which one matters more². And the writing group found no research that targeted isolation specifically to improve heart health².

The Surgeon General’s plan puts most of the work on communities

In 2023, the U.S. Surgeon General issued an advisory on what it called an epidemic of loneliness and isolation³. Our articles on loneliness and on wellness groups cover its mortality comparisons and the World Health Organization’s 2025 estimates, so here is the part those articles skip: the plan.

It rests on six pillars: strengthen social infrastructure, such as community programs and gathering places; pass policies that support connection; mobilize the health sector, including training clinicians to assess patients; reform digital environments; deepen research; and build a culture of connection³⁴.

Most pillars ask communities, governments, technology companies and health systems, not individuals, to make connection easier.

The advisory also describes connection in three parts³. Structure is how many people you have and how often you see them. Function is whether you can count on them, and quality is whether those ties feel good.

Americans spent an average of 285 minutes a day alone in 2003 and 333 minutes in 2020, roughly 24 more hours a month³. In 2021, 49% said they had three or fewer close friends, up from 27% in 1990³.

Two survey questions now track connection, and Medicare asks too

In 2022, CDC’s Behavioral Risk Factor Surveillance System asked adults in 26 states how often they felt socially isolated from others. It also asked how often they got the social and emotional support they needed⁶.

About 32% said they felt isolated at least sometimes, which the CDC counted as loneliness. About 24% said they got the support they needed only sometimes, rarely or never⁶. For 2023, the first question was reworded to ask directly how often people feel lonely⁶.

Loneliness was reported by 43% of adults 18 to 34, compared with 24% of those 65 and older⁶. Income mattered too: 48% in households earning under $25,000 reported it, versus 21% at $150,000 or more⁶.

The mental health gap is wide. A history of depression was reported by 38 of every 100 lonely adults, compared with 14 of every 100 who weren’t lonely⁶. A survey can’t say which came first, and the AHA found the link runs both ways: isolated people were more likely to be depressed, and depressed people more likely to be isolated¹.

What Medicare and hospitals ask

If you have Medicare, your yearly wellness visit includes a health risk questionnaire. CMS guidance lists the topics it must cover at a minimum, and the psychosocial list includes loneliness and social isolation alongside depression, stress and fatigue⁷⁸.

Other federal efforts have shifted. In 2024, Medicare began paying for a separate social-needs risk assessment, and clinicians billed it more than 235,000 times that year⁹. For 2026, the Centers for Medicare & Medicaid Services (CMS) rewrote that billing code to cover physical activity and nutrition instead⁹¹⁰.

CMS also dropped the measures that had required hospitals to report how often they screened patients for social drivers of health. Its 2026 hospital payment rule, released July 31, 2025, said the costs outweighed the benefit¹¹. In the same rule-making, CMS asked the public how it might someday measure well-being, including social connection¹¹.

The lesson for you: official checkboxes come and go, but nothing stops you from raising the subject. The AHA’s Cené urged clinicians to ask patients how often they socialize and whether they’re satisfied, then point lonely patients to community resources¹.

Friendship runs on hours, and some hours count more

Hall ran two studies. Besides the 355 adults who had recently moved, he followed 112 new University of Kansas students during their first weeks of college¹². Combining both, casual friendship came at 40 to 60 hours together, friendship at 80 to 100 hours, and close friendship at more than 200¹².

Not all hours counted equally. People who stayed acquaintances usually had spent no more than 30 hours together¹³. Some had logged hundreds of hours beside coworkers they still called acquaintances¹³.

What moved friendships forward was shared leisure: hanging out, joking around and catching up on each other’s lives¹²¹³. Time spent working together counted less¹². When a friendship did deepen, people doubled or tripled their time together within about three weeks¹².

That adds up to a real budget. By our arithmetic, 200 hours at two hours a week takes almost two years. At five hours a week, it takes about nine months.

Hall’s advice was to make time with potential friends a priority and to change the setting, such as turning a coworker into a lunch companion¹².

This is why routine places matter. A weekly class, a congregation, a garden plot or a standing coffee table piles up shared hours without a fresh invitation each time. Some people call these third places: not home, not work. The advisory’s first pillar asks communities to build and fund them³.

Treat the hour counts as rough guides. They come from people’s survey answers, in two groups who had just moved¹².

Men’s friendship circles have thinned the most

A 2021 think-tank survey shows how this plays out for men. The Survey Center on American Life, which runs the national American Perspectives Survey, found that 15% of men said they had no close friends, up from 3% in 1990¹⁴.

The share of men with six or more close friends fell from 55% to 27% over the same years¹⁴. Among men not in a romantic relationship, 20% reported no close friends at all¹⁴.

CDC’s survey points the same way. Men were more likely than women to say they lacked the social and emotional support they needed, 26% versus 22%⁶.

Polls taken decades apart can differ in method, so treat the exact numbers with some caution. The direction, though, matches the advisory’s close-friend trend³.

Our reading of these numbers: if a partner is a man’s main confidant, a divorce or a death can remove most of his support at once. The AHA flagged widowhood, and CDC lists divorce and the loss of a loved one among the risk factors¹⁵.

What has evidence for building connection

The AHA’s review saw promise in fitness classes and recreation at senior centers, and in programs that tackle negative thinking and low self-worth¹². Its writing group called for more research on how such efforts help¹.

Our article on loneliness reviews the trials of those thinking-skill programs. Our article on social support covers social prescribing, where a clinician refers patients to a worker who links them with community support. Our article on purpose describes a volunteer program that paired older adults with schoolchildren.

The sources also disagree on one point. The Surgeon General’s advisory says chronic loneliness and isolation can raise dementia risk by about 50% in older adults³. The AHA’s review judged the dementia evidence sparse or mixed¹².

Claim	Evidence level	What it rests on
Isolation and loneliness are linked to heart disease and stroke	Strong evidence	AHA review of observational studies; a link, not proof of cause12
Isolation and loneliness are linked to dementia	Promising but early	Advisory cites about 50% higher risk; AHA judged data sparse or mixed13
Fitness and senior-center recreation programs ease isolation and loneliness	Promising but early	Studies reviewed by the AHA12
Programs that target negative thinking ease loneliness	Promising but early	AHA review12
Building connection lowers heart attack or stroke risk	Not enough evidence	No trials found2
Shared leisure hours turn acquaintances into friends	Promising but early	Two survey studies1213

Your weekly connection audit

This audit is our own tool. It borrows the advisory’s three parts of connection, adds Hall’s hours and a giving check, and ends with one step³¹².

It takes about ten minutes on a Sunday evening.

Part	Question for this week	How to score it
Structure	How many people did I talk with beyond small talk? How many in person?	Count them: 0, 1 to 2, or 3 or more
Function	Who could I call at 2 a.m.? Who would ask me for help?	Write names; a blank is a gap
Quality	Which conversation left me feeling understood?	Name one, or write “none”
Hours	How many leisure hours did I spend with someone I’d like to be closer to?	Add to a running total; 50, 90 and 200 are milestones
Place	Did I show up at one recurring place or group?	Yes or no
Giving	Did I help someone, even in a small way?	Yes or no

Once a month, ask yourself the CDC’s two questions: how often you felt isolated, and how often you got the support you needed. Answer always, usually, sometimes, rarely or never⁶. Watch the trend, not one bad week.

Then pick your one step. Choose the weakest row and do one thing about it:

• Hours low? Turn one existing contact into a standing hour, such as a weekly walk.
• No place? Pick one recurring group and go at least four times before judging it.
• Function blank? Make one small, specific request of someone.
• Quality “none”? Ask one person a real question about their life, then listen.

Here is an example, for illustration only. Picture a recently widowed man whose wife kept the couple’s calendar. His audit shows three in-person contacts but no one to call at 2 a.m. His one step: invite a neighbor to the Saturday farmers market, every week, for a month.

Connection is the oldest prevention habit

Natural health has long trusted what people can do for each other: shared meals, sitting with the sick, passing down skills in a kitchen or garden. The research suggests that instinct was sound.

Connection costs little, needs no prescription and can’t be bought in a bottle. It does take hours, and those hours are an investment worth tracking as carefully as your steps.

When loneliness needs more than a plan

Loneliness can travel with depression. In the CDC survey, 38% of lonely adults reported a history of depression⁶. If loneliness comes with lasting sadness or hopelessness, tell a clinician; the AHA urges clinicians to ask about isolation and connect patients with help¹.

If you or someone you know is in distress or thinking about suicide, call 988. The 988 Suicide and Crisis Lifeline offers free, confidential support 24 hours a day, and the Surgeon General’s office lists it for people struggling with loneliness⁴.

Questions readers ask

The bottom line

The heart research is clear on direction: people who are isolated or lonely have more heart attacks and strokes, though no trial has yet shown that fixing loneliness prevents them. Friendship itself runs on time, and close ties take hundreds of hours of shared leisure.

Treat connection like any other prevention habit. Measure it weekly, answer the wellness-visit questions frankly, and spend your hours where friendships can grow. If loneliness turns into hopelessness, reach out to a clinician or call 988.

Related reading

• What eases loneliness, which depends less on how many people you see
• The right kind of help beats more help, and giving it counts too
• People come to wellness groups for answers and stay for belonging
• Purpose tracks with a longer life, while the Blue Zones story is less certain
• Almost one in four adults who report good hearing show signs of noise damage

Sources

1. American Heart Association. “Social isolation, loneliness can damage heart and brain health, report says” (on Cené CW, Beckie TM, et al., Journal of the American Heart Association, 2022, doi:10.1161/JAHA.122.026493). AHA News, August 4, 2022. heart.org
2. American Heart Association. News release on the scientific statement “Social Isolation and Loneliness: Impact on Cardiovascular and Brain Health.” EurekAlert, August 4, 2022. sciencesources.eurekalert.org
3. U.S. Surgeon General. “Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community.” U.S. Department of Health and Human Services, 2023. hhs.gov
4. Office of the Surgeon General. “Social Connection Resources” (framework and resource page). U.S. Department of Health and Human Services. hhs.gov
5. Centers for Disease Control and Prevention. “Health Effects of Social Isolation and Loneliness.” CDC, last reviewed March 26, 2024. cdc.gov
6. Bruss KV, Seth P, Zhao G. “Loneliness, Lack of Social and Emotional Support, and Mental Health Issues — United States, 2022.” Morbidity and Mortality Weekly Report, 2024;73(24):539–545. cdc.gov
7. Centers for Medicare & Medicaid Services. “Initial Preventive Physical Examination and Annual Wellness Visit: Frequently Asked Questions.” CMS, 2012. cms.gov
8. Nothelle S, Cayea D, Colburn J. “Medicare Annual Wellness Visits.” Elder Care (Johns Hopkins University School of Medicine), January 2023. aging.arizona.edu
9. DecisionHealth. “Code swap: Remember that G0136 now covers physical activity, nutrition.” Part B News, May 28, 2026. pbn.decisionhealth.com
10. First Coast Service Options (Medicare Administrative Contractor). “Revision to social determinants of health risk assessment (HCPCS code G0136).” March 25, 2026. medicare.fcso.com
11. American Society of Hematology. “FY 2026 Medicare Inpatient Prospective Payment System Rule” (summary of CMS-1833-F). ASH, 2025.
12. University of Kansas. “How to make friends? Study reveals how many hours it takes” (on Hall JA, Journal of Social and Personal Relationships, 2018, doi:10.1177/0265407518761225). KU News, March 2018. news.ku.edu
13. Denworth L. “How Do You Make or Maintain Friends? Put in the Time.” Psychology Today, March 30, 2018. psychologytoday.com
14. Fox News. “American men experiencing ‘friendship recession’: report” (on the Survey Center on American Life’s May 2021 American Perspectives Survey). July 2021. foxnews.com