Allostatic load and cardiovascular outcomes in males with prostate cancer

Nickolas Stabellini; Jennifer Cullen; Marcio S Bittencourt; Justin X Moore; Lifen Cao; Neal L Weintraub; Ryan A Harris; Xiaoling Wang; Biplab Datta; Steven S Coughlin; Jorge Garcia; John Shanahan; Nelson Hamerschlak; Kristin Waite; Nathanael R Fillmore; Martha Terris; Alberto J Montero; Jill S Barnholtz-Sloan; Avirup Guha

doi:10.1093/jncics/pkad005

Allostatic load and cardiovascular outcomes in males with prostate cancer

Nickolas Stabellini, Jennifer Cullen, Marcio S Bittencourt, Justin X Moore, Lifen Cao, Neal L Weintraub, Ryan A Harris, Xiaoling Wang, Biplab Datta, Steven S Coughlin, Jorge Garcia, John Shanahan, Nelson Hamerschlak, Kristin Waite, Nathanael R Fillmore, Martha Terris, Alberto J Montero, Jill S Barnholtz-Sloan, Avirup Guha

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Abstract

Background Cardiovascular disease (CVD) is the leading cause of death in men with prostate cancer (PC). Accumulated stress plays an important role in CVD development. The cumulative burden of chronic stress and life events can be measured using allostatic load (AL). Methods The initial cohort included males aged 18 years and older diagnosed with PC (2005-2019). AL was modeled as an ordinal variable (0-11). Fine-Gray competing risk regressions measured the impact of precancer diagnosis AL and postdiagnosis AL in 2-year major cardiac events (MACE). The effect of AL changes over time on MACE development was calculated via piecewise Cox regression (before, and 2 months, 6 months, and 1 year after PC diagnosis). Results We included 5261 PC patients of which 6.6% had a 2-year MACE. For every 1-point increase in AL before and within 60 days after PC diagnosis, the risk of MACE increased 25% (adjusted hazard ratio [aHR] =1.25, 95% confidence interval [CI] = 1.18 to 1.33) and 27% (aHR = 1.27, 95% CI = 1.20 to 1.35), respectively. Using AL as a time-varying exposure, the risk of MACE increased 19% (aHR = 1.19, 95% CI = 1.11 to 1.27), 22% (aHR = 1.22, 95% CI = 1.14 to 1.33), 28% (aHR = 1.28, 95% CI = 1.23 to 1.33), and 31% (aHR = 1.31, 95% CI = 1.27 to 1.35) for every 1-point increase in AL before, 2 months after, 6 months after, and 1 year after PC diagnosis, respectively. Conclusion AL and its changes over time are associated with MACE in PC patients, suggesting a role of a biological measure of stress as a marker of CVD risk among men with PC.

Original language	English
Article number	pkad005
Journal	JNCI cancer spectrum
Volume	7
Issue number	2
Early online date	8 Feb 2023
DOIs	https://doi.org/10.1093/jncics/pkad005
Publication status	Published online - 8 Feb 2023

Bibliographical note

Funding Information:
Patient records were deidentified, and the study was approved by the University Hospitals of Cleveland institutional review board. The authors' funders did not play a role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication. This work was presented as a poster at the 2022 American Heart Association Scientific Sessions.

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press.

Keywords

Cancer Research
Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/jncics/pkad005

pkad005Author Accepted Manuscript, 884 KBLicence: CC BY

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Stabellini, N., Cullen, J., Bittencourt, M. S., Moore, J. X., Cao, L., Weintraub, N. L., Harris, R. A., Wang, X., Datta, B., Coughlin, S. S., Garcia, J., Shanahan, J., Hamerschlak, N., Waite, K., Fillmore, N. R., Terris, M., Montero, A. J., Barnholtz-Sloan, J. S., & Guha, A. (2023). Allostatic load and cardiovascular outcomes in males with prostate cancer. JNCI cancer spectrum, 7(2), Article pkad005. Advance online publication. https://doi.org/10.1093/jncics/pkad005

@article{65d66b40504e44e2a86a95ad58596331,

title = "Allostatic load and cardiovascular outcomes in males with prostate cancer",

abstract = "Background Cardiovascular disease (CVD) is the leading cause of death in men with prostate cancer (PC). Accumulated stress plays an important role in CVD development. The cumulative burden of chronic stress and life events can be measured using allostatic load (AL). Methods The initial cohort included males aged 18 years and older diagnosed with PC (2005-2019). AL was modeled as an ordinal variable (0-11). Fine-Gray competing risk regressions measured the impact of precancer diagnosis AL and postdiagnosis AL in 2-year major cardiac events (MACE). The effect of AL changes over time on MACE development was calculated via piecewise Cox regression (before, and 2 months, 6 months, and 1 year after PC diagnosis). Results We included 5261 PC patients of which 6.6% had a 2-year MACE. For every 1-point increase in AL before and within 60 days after PC diagnosis, the risk of MACE increased 25% (adjusted hazard ratio [aHR] =1.25, 95% confidence interval [CI] = 1.18 to 1.33) and 27% (aHR = 1.27, 95% CI = 1.20 to 1.35), respectively. Using AL as a time-varying exposure, the risk of MACE increased 19% (aHR = 1.19, 95% CI = 1.11 to 1.27), 22% (aHR = 1.22, 95% CI = 1.14 to 1.33), 28% (aHR = 1.28, 95% CI = 1.23 to 1.33), and 31% (aHR = 1.31, 95% CI = 1.27 to 1.35) for every 1-point increase in AL before, 2 months after, 6 months after, and 1 year after PC diagnosis, respectively. Conclusion AL and its changes over time are associated with MACE in PC patients, suggesting a role of a biological measure of stress as a marker of CVD risk among men with PC.",

keywords = "Cancer Research, Oncology",

author = "Nickolas Stabellini and Jennifer Cullen and Bittencourt, {Marcio S} and Moore, {Justin X} and Lifen Cao and Weintraub, {Neal L} and Harris, {Ryan A} and Xiaoling Wang and Biplab Datta and Coughlin, {Steven S} and Jorge Garcia and John Shanahan and Nelson Hamerschlak and Kristin Waite and Fillmore, {Nathanael R} and Martha Terris and Montero, {Alberto J} and Barnholtz-Sloan, {Jill S} and Avirup Guha",

note = "Funding Information: Patient records were deidentified, and the study was approved by the University Hospitals of Cleveland institutional review board. The authors' funders did not play a role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication. This work was presented as a poster at the 2022 American Heart Association Scientific Sessions. Publisher Copyright: {\textcopyright} The Author(s) 2023. Published by Oxford University Press.",

year = "2023",

month = feb,

day = "8",

doi = "10.1093/jncics/pkad005",

language = "English",

volume = "7",

journal = "JNCI cancer spectrum",

issn = "2515-5091",

publisher = "Oxford University Press",

number = "2",

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Stabellini, N, Cullen, J, Bittencourt, MS, Moore, JX, Cao, L, Weintraub, NL, Harris, RA, Wang, X, Datta, B, Coughlin, SS, Garcia, J, Shanahan, J, Hamerschlak, N, Waite, K, Fillmore, NR, Terris, M, Montero, AJ, Barnholtz-Sloan, JS & Guha, A 2023, 'Allostatic load and cardiovascular outcomes in males with prostate cancer', JNCI cancer spectrum, vol. 7, no. 2, pkad005. https://doi.org/10.1093/jncics/pkad005

TY - JOUR

T1 - Allostatic load and cardiovascular outcomes in males with prostate cancer

AU - Stabellini, Nickolas

AU - Cullen, Jennifer

AU - Bittencourt, Marcio S

AU - Moore, Justin X

AU - Cao, Lifen

AU - Weintraub, Neal L

AU - Harris, Ryan A

AU - Wang, Xiaoling

AU - Datta, Biplab

AU - Coughlin, Steven S

AU - Garcia, Jorge

AU - Shanahan, John

AU - Hamerschlak, Nelson

AU - Waite, Kristin

AU - Fillmore, Nathanael R

AU - Terris, Martha

AU - Montero, Alberto J

AU - Barnholtz-Sloan, Jill S

AU - Guha, Avirup

N1 - Funding Information: Patient records were deidentified, and the study was approved by the University Hospitals of Cleveland institutional review board. The authors' funders did not play a role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication. This work was presented as a poster at the 2022 American Heart Association Scientific Sessions. Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press.

PY - 2023/2/8

Y1 - 2023/2/8

N2 - Background Cardiovascular disease (CVD) is the leading cause of death in men with prostate cancer (PC). Accumulated stress plays an important role in CVD development. The cumulative burden of chronic stress and life events can be measured using allostatic load (AL). Methods The initial cohort included males aged 18 years and older diagnosed with PC (2005-2019). AL was modeled as an ordinal variable (0-11). Fine-Gray competing risk regressions measured the impact of precancer diagnosis AL and postdiagnosis AL in 2-year major cardiac events (MACE). The effect of AL changes over time on MACE development was calculated via piecewise Cox regression (before, and 2 months, 6 months, and 1 year after PC diagnosis). Results We included 5261 PC patients of which 6.6% had a 2-year MACE. For every 1-point increase in AL before and within 60 days after PC diagnosis, the risk of MACE increased 25% (adjusted hazard ratio [aHR] =1.25, 95% confidence interval [CI] = 1.18 to 1.33) and 27% (aHR = 1.27, 95% CI = 1.20 to 1.35), respectively. Using AL as a time-varying exposure, the risk of MACE increased 19% (aHR = 1.19, 95% CI = 1.11 to 1.27), 22% (aHR = 1.22, 95% CI = 1.14 to 1.33), 28% (aHR = 1.28, 95% CI = 1.23 to 1.33), and 31% (aHR = 1.31, 95% CI = 1.27 to 1.35) for every 1-point increase in AL before, 2 months after, 6 months after, and 1 year after PC diagnosis, respectively. Conclusion AL and its changes over time are associated with MACE in PC patients, suggesting a role of a biological measure of stress as a marker of CVD risk among men with PC.

AB - Background Cardiovascular disease (CVD) is the leading cause of death in men with prostate cancer (PC). Accumulated stress plays an important role in CVD development. The cumulative burden of chronic stress and life events can be measured using allostatic load (AL). Methods The initial cohort included males aged 18 years and older diagnosed with PC (2005-2019). AL was modeled as an ordinal variable (0-11). Fine-Gray competing risk regressions measured the impact of precancer diagnosis AL and postdiagnosis AL in 2-year major cardiac events (MACE). The effect of AL changes over time on MACE development was calculated via piecewise Cox regression (before, and 2 months, 6 months, and 1 year after PC diagnosis). Results We included 5261 PC patients of which 6.6% had a 2-year MACE. For every 1-point increase in AL before and within 60 days after PC diagnosis, the risk of MACE increased 25% (adjusted hazard ratio [aHR] =1.25, 95% confidence interval [CI] = 1.18 to 1.33) and 27% (aHR = 1.27, 95% CI = 1.20 to 1.35), respectively. Using AL as a time-varying exposure, the risk of MACE increased 19% (aHR = 1.19, 95% CI = 1.11 to 1.27), 22% (aHR = 1.22, 95% CI = 1.14 to 1.33), 28% (aHR = 1.28, 95% CI = 1.23 to 1.33), and 31% (aHR = 1.31, 95% CI = 1.27 to 1.35) for every 1-point increase in AL before, 2 months after, 6 months after, and 1 year after PC diagnosis, respectively. Conclusion AL and its changes over time are associated with MACE in PC patients, suggesting a role of a biological measure of stress as a marker of CVD risk among men with PC.

KW - Cancer Research

KW - Oncology

UR - http://www.scopus.com/inward/record.url?scp=85160083332&partnerID=8YFLogxK

U2 - 10.1093/jncics/pkad005

DO - 10.1093/jncics/pkad005

M3 - Article

C2 - 36752520

SN - 2515-5091

VL - 7

JO - JNCI cancer spectrum

JF - JNCI cancer spectrum

IS - 2

M1 - pkad005

ER -

Allostatic load and cardiovascular outcomes in males with prostate cancer

Abstract

Bibliographical note

Keywords

UN SDGs

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