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Allostatic Load/Chronic Stress and Cardiovascular Outcomes in Patients Diagnosed With Breast, Lung, or Colorectal

Nickolas Stabellini1,2,3,4, Jennifer Cullen1,5, Marcio S Bittencourt6

  • 1Case Western Reserve University School of Medicine, Case Western Reserve University Cleveland OH USA.

Journal of the American Heart Association
|July 9, 2024
PubMed

Insights

Chronic stress, measured as allostatic load (AL), increases cardiovascular risk in cancer patients. Higher AL is linked to major adverse cardiac events (MACE) in breast, lung, and colorectal cancer survivors, especially post-diagnosis.

Area of Science:

  • Oncology
  • Cardiology
  • Stress Physiology

Background:

  • Cardiovascular disease and cancer share chronic stress/allostatic load (AL) as a common risk factor.
  • While AL's link to major cardiac events (MACE) is known in prostate cancer, its impact on MACE in breast, lung, and colorectal cancers was previously unstudied.

Purpose of the Study:

  • To investigate the association between allostatic load (AL) and the risk of major adverse cardiac events (MACE) in patients with breast, lung, or colorectal cancer.
  • To analyze how changes in AL over time influence MACE risk following cancer diagnosis.

Main Methods:

  • Retrospective cohort study of 16,467 patients diagnosed with breast, lung, or colorectal cancer between 2010-2019.
  • Allostatic load (AL) was modeled ordinally (0-11) and analyzed as a pre-diagnosis and time-varying exposure.
  • Adjusted Fine-Gray competing risks regressions and piecewise Cox regressions were used to estimate the impact of AL on 2-year MACE.

Main Results:

  • A 1-point increase in AL before diagnosis was associated with a 10% increased MACE risk in breast cancer (aHR 1.10), 16% in lung cancer (aHR 1.16), and 13% in colorectal cancer (aHR 1.13).
  • The highest MACE risk was observed with a 1-point AL increase between 6 and 12 months post-diagnosis for all three cancer types.
  • Major adverse cardiac events (MACE) included heart failure, ischemic stroke, acute coronary syndrome, and atrial fibrillation.

Conclusions:

  • Allostatic load (AL) is a significant predictor of cardiovascular risk in patients with breast, lung, and colorectal cancer.
  • AL may serve as a valuable biomarker for identifying cancer patients at high risk for MACE.
  • Targeting AL could lead to timely cardiovascular interventions in cancer survivors.
Abstract

Keywords:
allostatic loadbreast cancercardiovascular diseasecolorectal cancerlung cancerstress

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