Chronic stress, as measured by the allostatic load, is higher among non-Hispanic Blacks compared with non-Hispanic Whites before a diagnosis of prostate cancer, but both groups experienced a similar increase after diagnosis and treatment with androgen deprivation therapy (ADT), according to a single-center study being presented during AHA 2022 in Chicago and published Oct. 31 in JACC: CardioOncology.

Allostatic load, a score calculated using biomarkers, is associated with as much as a 130% increase in the risk of cardiovascular disease with a 1-unit increase over a nearly 10-year period. ADT is associated with an increase in the risk of cardiovascular disease and this risk is known to be significantly higher in non-Hispanic Blacks.

Nickolas Stabellini, BS, et al., used generalized multivariable mixed-effects models to examine whether ADT could lead to a greater increase in cardiovascular disease among non-Hispanic Black men than non-Hispanic White men ≥18 years of age who were diagnosed with prostate cancer between 2004-2022 at the University Hospitals Seidman Cancer Center. 

Allostatic load (an ordinal measure from 0 to 11) was calculated before cancer diagnosis and then monthly for the first year. One point was assigned for these cutoffs: systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, heart rate >100 beats/min, total cholesterol ≥240 mg/dL, HDL-C ≤50 mg/dL, triglycerides ≥150 mg/dL, glycosylated hemoglobin ≥6.5%, body mass index ≥30kg/m², glucose ≥110 mg/dL, C-reactive protein >3 mg/L, and interleukin-6 >1.8 pg/mL.

Of the 7,168 participants (mean age, 68 years), 1,570 were non-Hispanic Black. Most had a Charlson score from 1 to 2 (59.3%), 14.4% had at least one cardiovascular disease factor, and 12.7% had a Gleason score ≥8. As for treatment, 25.8% had surgery, 31.9% received radiotherapy, and 20.9% received ADT.

Results showed no significant racial difference in the increase in allostatic load among those receiving ADT (0.08 ± 0.05; p=0.080). The median allostatic load before cancer diagnosis for the entire population was 2 (IQR, 0-4) and it rose to 3 (IQR, 1-4) after the first year of diagnosis. Compared with patients not taking ADT, the average estimated monthly variation in allostatic load was 0.10 ± 0.04 higher among non-Hispanic Blacks on ADT (p=0.025) and 0.16 ± 0.02 higher among non-Hispanic Whites on ADT (p<0.001).

The authors note that although no significant difference was seen by self-identified race, the “precancer [allostatic load]/level of chronic stress and non-ADT-related increase in [allostatic load] may explain racial differences in ADT-related [cardiovascular disease].”

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Hypertriglyceridemia, Lipid Metabolism, Nonstatins

Keywords: AHA Annual Scientific Sessions, AHA22, Glucose, Triglycerides, Cholesterol, Biomarkers, Prostatic Neoplasms, Race Factors, Neoplasm Grading, Heart Rate, Blood Pressure, Body Mass Index, Cardiovascular Diseases, Receptors, Interleukin-6, Androgens, Androgen Antagonists, C-Reactive Protein, Glycated Hemoglobin A, African Americans, Allostasis

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