The mediation role of allostatic load/chronic stress on the relationship between cancer survivorship and cardiovascular disease mortality.

Autor:	Stabellini N; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States.; Case Western Reserve University School of Medicine, Case Western Reserve University Cleveland, OH, United States.; Department of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, United States.; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Nettles D; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States.; Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, United States., Nain P; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States.; Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, United States., Moore JX; Center for Health Equity Transformation, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States.; Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, United States.; Community Impact, Markey Cancer Center, University of Kentucky, Lexington, KY, United States., L Weintraub N; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States., Patel SA; Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States., Barata P; Department of Hematology and Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States., Tsai MH; Georgia Prevention Institute, Augusta University, Augusta, GA 30912, United States., Al-Kindi S; Center for CV Computational & Precision Health (C3-PH), Houston Methodist Hospital, Houston, TX, United States.; Division of Cardiovascular Prevention & Wellness, Houston Methodist Hospital, Houston, TX, United States., Guha A; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States.; Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, United States.
Jazyk:	angličtina
Zdroj:	American heart journal plus : cardiology research and practice [Am Heart J Plus] 2024 Jul 28; Vol. 45, pp. 100429. Date of Electronic Publication: 2024 Jul 28 (Print Publication: 2024).
DOI:	10.1016/j.ahjo.2024.100429
Abstrakt:	Background: Cancer survivors face an elevated risk of cardiovascular disease (CVD) and cardiovascular disease mortality (CVDm) compared to the general population. Allostatic load (AL), a composite score reflecting cardiovascular, metabolic, and immune markers, assesses the cumulative impact of chronic stress and life events. Increased AL in cancer patients is linked to up to a 30 % higher CVD risk. We hypothesized that cancer diagnosis and therapy contribute to increased AL, mediating the association between cancer survivorship and CVDm. Methods: This retrospective cohort study analyzed National Health and Nutrition Examination Survey (NHANES) data linked with the National Death Index (NDI) from 1988 to 2019. Cancer survivorship (yes vs. no), AL, and CVDm were the exposure, mediator, and outcome variables, respectively. Mediation analyses adapted to survival outcomes were performed. Results: Among 14,416 participants, cancer survivors <65 years-old exhibited a 41 % higher associated CVDm risk. High AL mediated 5.4 %, 8.9 %, and 3.6 % of the effect for all adults, 18-64 years, and ≥65 years, respectively. Black patients <65 years-old had an 84 % higher associated CVDm risk, with AL mediating 9.2 %, 5.8 %, and 12.6 % for all adults, 18-64 years, and ≥65 years, respectively. White patients showed a 20 % higher associated CVDm risk, with AL mediating 4.4 %, 2.8 %, and 5.7 % for all adults, 18-64 years, and ≥65 years, respectively. Conclusions: Increased CVDm risk among cancer survivors, particularly in Black individuals, is associated with higher AL mediation. These disparities may stem from social determinants of health. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (© 2024 The Authors.)
Databáze:	MEDLINE
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