Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 16;13(14):e033295.
doi: 10.1161/JAHA.123.033295. Epub 2024 Jul 9.

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

Nickolas Stabellini  1   2   3   4 , Jennifer Cullen  1   5 , Marcio S Bittencourt  6 , Justin X Moore  7 , Arnethea Sutton  8 , Priyanshu Nain  4 , Nelson Hamerschlak  9 , Neal L Weintraub  4   10 , Susan Dent  11 , Meng-Han Tsai  12   13 , Amitava Banerjee  14 , Arjun K Ghosh  15 , Diego Sadler  16 , Steven S Coughlin  4   17 , Ana Barac  18 , John Shanahan  19 , Alberto J Montero  2 , Avirup Guha  4   20
Affiliations

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

Nickolas Stabellini et al. J Am Heart Assoc. .

Abstract

Background: Cardiovascular disease and cancer share a common risk factor: chronic stress/allostatic load (AL). A 1-point increase in AL is linked to up to a 30% higher risk of major cardiac events (MACE) in patients with prostate cancer. However, AL's role in MACE in breast cancer, lung cancer, or colorectal cancer remains unknown.

Methods and results: Patients ≥18 years of age diagnosed with the mentioned 3 cancers of interest (2010-2019) and followed up at a large, hybrid academic-community practice were included in this retrospective cohort study. AL was modeled as an ordinal measure (0-11). Adjusted Fine-Gray competing risks regressions estimated the impact of AL precancer diagnosis on 2-year MACE (a composite of heart failure, ischemic stroke, acute coronary syndrome, and atrial fibrillation). The effect of AL changes over time on MACE was calculated via piecewise Cox regression (before, and 2 months, 6 months, and 1 year after cancer diagnosis). Among 16 467 patients, 50.5% had breast cancer, 27.9% had lung cancer, and 21.4% had colorectal cancer. A 1-point elevation in AL before breast cancer diagnosis corresponded to a 10% heightened associated risk of MACE (adjusted hazard ratio, 1.10 [95% CI, 1.06-1.13]). Similar findings were noted in lung cancer (adjusted hazard ratio, 1.16 [95% CI, 1.12-1.20]) and colorectal cancer (adjusted hazard ratio, 1.13 [95% CI, 1.08-1.19]). When considering AL as a time-varying exposure, the peak associated MACE risk occurred with a 1-point AL rise between 6 and 12 months post- breast cancer, lung cancer, and colorectal cancer diagnosis.

Conclusions: AL warrants investigation as a potential marker in these patients to identify those at elevated cardiovascular risk and intervene accordingly.

Keywords: allostatic load; breast cancer; cardiovascular disease; colorectal cancer; lung cancer; stress.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Consolidated Standards of Reporting Trials diagram describing the patient selection for this study.
See this image and copyright information in PMC

References

    1. Bray F, Laversanne M, Weiderpass E, Soerjomataram I. The ever‐increasing importance of cancer as a leading cause of premature death worldwide. Cancer. 2021;127:3029–3030. doi: 10.1002/cncr.33587 - DOI - PubMed
    1. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74:12–49. doi: 10.3322/caac.21820 - DOI - PubMed
    1. Multiple Cause of Death Data on CDC WONDER. Accessed April 29, 2024. https://wonder.cdc.gov/mcd.html.
    1. Koene RJ, Prizment AE, Blaes A, Konety SH. Shared risk factors in cardiovascular disease and cancer. Circulation. 2016;133:1104–1114. doi: 10.1161/CIRCULATIONAHA.115.020406 - DOI - PMC - PubMed
    1. Strongman H, Gadd S, Matthews A, Mansfield KE, Stanway S, Lyon AR, Dos‐Santos‐Silva I, Smeeth L, Bhaskaran K. Medium and long‐term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population‐based cohort study using multiple linked UK electronic health records databases. Lancet. 2019;394:1041–1054. doi: 10.1016/S0140-6736(19)31674-5 - DOI - PMC - PubMed

LinkOut - more resources