Can allostatic load in pregnancy explain the association between race and subsequent cardiovascular disease risk: A cohort study

Abstract

Objective: To assess the relationship between allostatic load, a measure of cumulative chronic stress in early pregnancy and cardiovascular disease risk, 2-7 years postpartum, and pathways contributing to racial disparities in cardiovascular disease risk. Design: Secondary analysis of a prospective cohort study. Setting Multicenter Population: Pregnant women. Methods: Our primary exposure was high allostatic load in the first trimester, defined as at least 4 of 12 biomarkers (systolic blood pressure, diastolic blood pressure, body mass index, cholesterol, low-density lipoprotein, high-density lipoprotein, high-sensitivity C-reactive protein, triglycerides, insulin, glucose, creatinine and albumin) in the unfavourable quartile. Logistic regression was used to test the association between high allostatic load and main outcome adjusted for confounders: time from index pregnancy and follow up, age, education, smoking, gravidity, bleeding in the first trimester, index adverse pregnancy outcomes, and health insurance. Each main outcome component and allostatic load were analysed secondarily. Mediation and moderation analyses assessed the role of high allostatic load in racial disparities of cardiovascular disease risk. Main outcome measure: Incident cardiovascular disease risk: hypertension, or metabolic disorders. Results: Cardiovascular disease risk was identified in 1462/4022 individuals (hypertension: 36.6%, metabolic disorder: 15.4%). After adjustment, allostatic load was associated with cardiovascular disease risk (adjusted odds ratio [aOR] 2.0, 95% CI 1.8-2.3), hypertension (aOR 2.1, 95% CI 1.8-2.4) and metabolic disorder (aOR 1.7, 95% CI 1.5-2.1). Allostatic load was a partial mediator between race and cardiovascular disease risk. Race did not significantly moderate this relationship. Conclusions: High allostatic load during pregnancy is associated with cardiovascular disease risk. The relationships between stress, subsequent cardiovascular risk and race warrant further study.

Association of Per- and Polyfluoroalkyl Substances with Allostatic Load Stratified by Herpes Simplex Virus 1 and 2 Exposure

“…Beyond the elevation of AL, scientific investigations have linked PFAS exposure to heightened cholesterol levels, alterations in liver enzymes, diminished vaccine response, and increased risk of hypertension in pregnant women and cardiovascular ailments [ 2 , 4 ]. Given that AL serves as a potential mediator for various chronic diseases [ 13 , 34 , 35 ], it is plausible that the relationship between PFAS and AL, particularly in the context of persistent infections, extends to encompass broader implications. In this light, it can be hypothesized that in the presence of a persistent infection, those exposed to PFAS may experience chronic stress, which over extended periods could contribute to chronic conditions such as cardiovascular disease, liver disorders, and cancer, among others.…”

Association between physical activity and allostatic load among pregnant women

“…To calculate AL, we focused on health disparities, combined with studies of population (Carbone et al, 2022) and gestational AL (Lueth et al, 2022(Lueth et al, , 2023Hux et al, 2014) Waist and hip circumferences were measured by tapes. The BMI was calculated as weight (kg) divided by height squared (m 2 ) and rounded to two decimal places.…”

“…These biomarkers include systolic blood pressure (SBP), diastolic blood pressure (DBP), resting pulse, high-density lipoprotein (HDL), low-density lipoprotein, body mass index (BMI), triglycerides, waist-hip ratio (WHR), epinephrine, norepinephrine, low-frequency heart variability, high-frequency heart variability, the standard deviation (SD) of R-R (heartbeat-to-heartbeat) intervals, cortisol, serum DHEA-S, plasma Creactive protein, fibrinogen, serum IL-6, glucose, insulin resistance, and HbA1c (Carbone et al, 2022). ALI during pregnancy consists of 5-12 biomarkers (Lueth et al, 2022(Lueth et al, , 2023Wallace & Harville, 2013;Hux et al, 2014). Among them, SBP, DBP, total cholesterol, HDL, BMI, and high-sensitivity C-reactive protein (hsCRP) were used more frequently.…”