Association between allostatic load and adverse outcomes among older patients with heart failure with preserved ejection fraction

Abstract

Background The present study aimed to investigate the association between allostatic load (AL) and adverse outcomes, including mortality and heart failure (HF) admission, among elderly male patients who had heart failure with preserved ejection fraction (HFpEF). Methods A prospective cohort study of 1111 elderly male patients with HFpEF, diagnosed between 2015 and 2019 and followed up through 2021. We constructed an AL measure using a combination of 10 biomarkers, including fasting glucose, hemoglobin, systolic blood pressure, diastolic blood pressure, heart rate, total cholesterol, triglycerides, highdensity lipoprotein cholesterol, neutrophil-to-lymphocyte ratio, and creatinine. The diagnosis of HFpEF was made according to the 2016 European Society of Cardiology guidelines. A Cox proportional hazards model was used to determine the associations between AL and adverse outcomes. Results In multivariate analysis, AL was significantly associated with increased risk of all-cause mortality (medium AL: adjusted hazard ratio [HR] = 2.75; 95% confidence interval [CI] 1.31–5.75; high AL: HR = 3.22; 95% CI 1.44–7.19; per-score increase: HR = 1.27; 95% CI 1.13–1.43), cardiovascular mortality (medium AL: HR = 3.42; 95% CI 1.16–10.13; high AL: HR = 4.14; 95% CI 1.27–13.43; per-score increase: HR = 1.28; 95% CI 1.07–1.53), non-cardiovascular mortality (medium AL: HR = 2.96; 95% CI 1.05–8.32; high AL: HR = 3.53; 95% CI 1.12–11.14; per-score increase: HR = 1.33; 95% CI 1.13–1.57), and HF admission (medium AL: HR = 2.32; 95% CI 1.10–4.87; high AL: HR = 3.03; 95% CI 1.33–6.92; per-score increase: HR = 1.24; 95% CI 1.10–1.40). Consistent results were found in multiple subgroup analyses. Conclusions A higher AL burden was associated with increased risk for poor prognosis in elderly men with HFpEF. AL relies on information that is easily obtained in regular physical examinations and can be assessed in various care and clinical settings to determine risk and help improve prognosis in patients with HFpEF.