Abstract 10750: Allostatic Load is Associated with Incident Heart Failure in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Abstract

Introduction: Allostatic load (AL) is the physiologic “wear and tear” on the body from adapting to stress. AL is associated with mortality for diseases including cancer and diabetes. While stress has been implicated in the development of heart failure (HF), no studies have studied the association between AL and HF. Hypothesis: Higher allostatic load is associated with incident HF events. Methods: We examined 16,765 participants without suspected HF at baseline from the REGARDS cohort. The main exposure was AL score quartile. AL score was based on baseline heart rate, systolic blood pressure (BP), diastolic BP, waist circumference, glucose, total cholesterol, high density lipoprotein cholesterol, albumin, c-reactive protein, urine albumin to creatinine ratio, and cystatin C. Each parameter was assigned points (0-3) based on quartiles within the sample, and total AL score ranged from 0-33. The main outcome was incident HF hospitalization or HF death. Cox proportional hazards models were adjusted for baseline demographics, geographic residence, socioeconomic factors, and lifestyle/health habits. Results: The mean age of the sample was 64 + 9.6 years, 61.5% were women, and 38.7% were Black individuals. Over a mean follow up of 9.9 years, there were 750 HF events (635 incident HF hospitalizations and 115 incident HF deaths). AL score Q1 included scores 1-12, Q2 13-16, Q3 17-20, and Q4 21-33 (Figure). Compared to Q1, hazards for incident HF event increased with AL quartile (Q2 HR 1.29, 95% CI 0.93-1.79; Q3 HR 2.06, 95% CI 1.51-2.81; Q4 HR 3.65, 95% CI 2.68-4.97) in a fully adjusted model. Conclusion: AL was associated with incident HF events. This study supports a relationship between physiologic dysregulation due to maladaptive stress response and the development of HF.