Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China.
Medical School of Chinese PLA, Beijing, China.
BMC Geriatr. 2023 Jun 9;23(1):360. doi: 10.1186/s12877-023-04091-x.
The allostatic load (AL) refers to the cumulative weakening of multiple physiological systems caused by repeated adaptation of the body to stressors There are still no studies have focused on the association between AL and the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). The present study aimed to investigate the association between AL and adverse outcomes, including mortality and HF admission, among elderly male patients with HFpEF.
We conducted 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 12 biomarkers. The diagnosis of HFpEF was made according to the 2021 European Society of Cardiology guidelines. A Cox proportional hazards model was used to determine the associations between AL and adverse outcomes.
In multivariate analysis, AL was significantly associated with increased risk of all-cause mortality (medium AL: adjusted hazard ratio [HR] = 2.53; 95% confidence interval [CI] 1.37-4.68; high AL: HR = 4.21; 95% CI 2.27-7.83; per-score increase: HR = 1.31; 95% CI 1.18-1.46), cardiovascular mortality (medium AL: HR = 2.67; 95% CI 1.07-6.68; high AL: HR = 3.13; 95% CI 1.23-7.97; per-score increase: HR = 1.20; 95% CI 1.03-1.40), non-cardiovascular mortality (medium AL: HR = 2.45; 95% CI 1.06-5.63; high AL: HR = 5.81; 95% CI 2.55-10.28; per-score increase: HR = 1.46; 95% CI 1.26-1.69), and HF admission (medium AL: HR = 2.68; 95% CI 1.43-5.01; high AL: HR = 3.24; 95% CI 1.69-6.23; per-score increase: HR = 1.24; 95% CI 1.11-1.39). Consistent results were found in multiple subgroup analyses.
A higher AL was associated with poor prognosis in elderly men with HFpEF. AL relies on information that is easily obtained in physical examinations and laboratory parameters and can be assessed in various care and clinical settings to help risk stratification of HFpEF patients.
体适能负荷（AL）是指身体对压力源的反复适应导致多个生理系统逐渐减弱的累积过程。目前尚无研究关注 AL 与射血分数保留的心力衰竭（HFpEF）患者预后之间的关系。本研究旨在探讨 AL 与老年男性 HFpEF 患者不良结局（包括死亡率和 HF 入院）之间的关系。
我们进行了一项前瞻性队列研究，纳入了 2015 年至 2019 年间诊断为 HFpEF 的 1111 名老年男性患者，并随访至 2021 年。我们使用 12 种生物标志物组合构建了 AL 测量值。HFpEF 的诊断依据是 2021 年欧洲心脏病学会指南。使用 Cox 比例风险模型确定 AL 与不良结局之间的关系。
在多变量分析中，AL 与全因死亡率增加显著相关（中 AL：调整后的危险比[HR] = 2.53；95%置信区间[CI] 1.37-4.68；高 AL：HR = 4.21；95% CI 2.27-7.83；每增加 1 分：HR = 1.31；95% CI 1.18-1.46）、心血管死亡率（中 AL：HR = 2.67；95% CI 1.07-6.68；高 AL：HR = 3.13；95% CI 1.23-7.97；每增加 1 分：HR = 1.20；95% CI 1.03-1.40）、非心血管死亡率（中 AL：HR = 2.45；95% CI 1.06-5.63；高 AL：HR = 5.81；95% CI 2.55-10.28；每增加 1 分：HR = 1.46；95% CI 1.26-1.69）和 HF 入院（中 AL：HR = 2.68；95% CI 1.43-5.01；高 AL：HR = 3.24；95% CI 1.69-6.23；每增加 1 分：HR = 1.24；95% CI 1.11-1.39）。在多个亚组分析中均得到了一致的结果。
较高的 AL 与老年男性 HFpEF 患者的预后不良相关。AL 依赖于体格检查和实验室参数中易于获得的信息，可在各种护理和临床环境中进行评估，有助于 HFpEF 患者的风险分层。
