Abstract
Introduction: The cumulative burden of chronic stress and life events can be measured by Allostatic load (AL), whose high values are related to poorer health outcomes and increased risk of cardiovascular disease (CVD). The primary objective of this study is to analyze the impact of androgen deprivation therapy (ADT) on AL variation in patients upon diagnosis of prostate cancer (PC). Hypothesis: ADT may increase AL variation in prostate cancer patients. Methods: Data were obtained from a Cleveland area integrated health care systems informatics platform. The initial cohort included males ≥18 years diagnosed with PC between 2005 and 2022. AL was calculated using multiple markers representing the cardiovascular, metabolic, and immune systems ( Table 1 ) before diagnosis and monthly during the first year. ADT use was captured based on prescribed medications. A linear-mixed-effects model, adjusted for patient demographics, CVD risk factors, and cancer characteristics, and treatment, was used to study AL monthly variation. The analysis was stratified by Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) race. Results: We analyzed a total of 7,168 PC adenocarcinoma patients (31.7% NHB vs 68.3% NHW), of which 20.9% received ADT. NHBs had higher AL pre-PC diagnosis than NHWs (p=0.001). AL monthly variation was 0.15 (±0.02) higher in all PC patients on ADT (p<0.001) and these results persisted stratifying by race (0.10 ± 0.04 for NHBs, p=0.01 and 0.16 ± 0.03 for NHW, p<0.001). There was no racial difference between AL increase in those receiving only ADT (0.09 +/- 0.04; p = 0.06). The details of individual AL variable measures pre-PC diagnosis and the mixed-effects model are presented in Table 1. Conclusion: Pre-PC-diagnosis chronic stress/AL is higher among NHBs vs. NHWs with the addition of ADT increasing AL in both races after PC diagnosis. This study is hypothesis-generating, offering data that help explain, in part, the racial differences in ADT-mediated CVD.
Published Version
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