Allostatic load and cardiovascular outcomes in males with prostate cancer.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in men with 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 ≥18 years diagnosed with PC (2005-2019). AL was modeled as an ordinal variable (0 to 11). Fine-Gray competing risk regressions measured the impact of pre-cancer diagnosis AL and post-diagnosis 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 5,261 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 Hazards Ratio [aHR] =1.25, 95% Confidence Interval [CI] = 1.18-1.33), and 27% (aHR=1.27; 95% CI = 1.20-1.35), respectively. Using AL as a time varying exposure, the risk of MACE increased 19% (aHR=1.19, 95% CI 1.11-1.27), 22% (aHR=1.22, 95% CI 1.14-1.33), 28% (aHR=1.28, 95% CI 1.23-1.33), and 31% (aHR=1.31, 95% CI 1.27-1.35) 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.