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 languageEnglish
    Article numberpkad005
    JournalJNCI cancer spectrum
    Volume7
    Issue number2
    Early online date8 Feb 2023
    DOIs
    Publication statusPublished 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

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