DOI: 10.1161/circ.148.suppl_1.14540 ISSN: 0009-7322

Abstract 14540: Allostatic Load/Chronic Toxic Stress and Cardiovascular Outcomes in Breast, Lung and Colon Cancer Patients

Nickolas Stabellini, Jennifer Cullen, Marcio S Bittencourt, Justin Moore, John Shanahan, Priyanshu Nain, Nelson Hamerschlak, Susan F Dent, Arnethea L Sutton, Meng-Han H Tsai, Amitava Banerjee, Arjun K Ghosh, Diego B Sadler, Alberto Montero, Avirup Guha
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Cardiovascular disease (CVD) and cancer share a common risk factor: chronic toxic stress/allostatic load (AL). Our previous research found that a 1-point increase in AL is linked to a 25-30% higher risk of major cardiac events (MACE) in prostate cancer patients.

Hypothesis: Higher AL is associated with increased MACE risk in patients with breast, lung, and colon cancer.

Methods: Patients ≥18 years diagnosed for the first time with the mentioned 3 cancers of interest between 2010-2019 at a large, hybrid academic-community practice were included in this retrospective cohort study. AL was modeled as an ordinal measure (0-11; Table 1 ). Adjusted Fine-Gray Cox proportional hazard regressions estimated the impact of AL pre- and 60 days post- cancer diagnosis on 2-year MACE.

Results: Demographic characteristics are summarized in Table 1. Two-year mace MACE occurred in 12.3%, 23.3%, and 9.7% of breast, lung, and colon cancer patients, respectively. Heart failure was the most common MACE, observed in 7.9%, 14.4%, and 4.8% of breast, lung, and colon cancer patients, respectively. Before cancer diagnosis, a 1-point increase in AL raised MACE risk by 11% (aHR=1.11, 95% CI 1.07-1.16) in breast cancer, 18% (aHR=1.18, 95% CI 1.11-1.25) in lung cancer, and 9% (aHR=1.09, 95% CI 1.01-1.18) in colon cancer. After cancer diagnosis, a 1-point increase in AL increased MACE risk by 10% (aHR=1.10, 95% CI 1.06-1.15) in breast cancer and 19% (aHR=1.19, 95% CI 1.12-1.25) in lung cancer, but was not statistically significant in colon cancer (aHR=1.07, 95% CI 0.99-1.16).

Conclusion(s): Higher AL levels prior to breast, lung, and colon cancer diagnoses are associated with increased MACE risk. Thus, effective implementation of patient-centered communication considering stress levels, stressors, and coping mechanisms is necessary during cardiovascular screening for these cancer patients. Further prospective studies are needed.

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