Abstract Details

Title Effects of Allostatic Load on Long-term Survival After Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-014

Objective To assess the relationship between allostatic load and its impact on all-cause mortality, cardiovascular mortality, and mortality after stroke.

Background Allostatic load index (ALI) is often utilized to evaluate the physiologic response to stress. This study seeks to assess the impact of ALI on mortality outcomes in stroke survivors and how race, ethnicity, and social factors impact these relationships.

Design/Methods Using data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File (National Death Index), we selected adults aged ≥ 25 years with self-reported stroke. We computed the weighted prevalence of each ALI category to obtain nationally representative estimates with higher ALI corresponding to a higher stress burden. We evaluated the relationship between ALI category and mortality outcomes using the Cox proportional hazard model considering the survey design variables, adjusting for age, sex, race/ethnicity, education, marital status, and income.

Results 15,567 individuals were included in this study. Of 414 individuals with a reported history of stroke, there were 11.8% ALI ≤ 1, 22.1% ALI = 2, and 66.1% ALI ≥3. Higher ALI correlated with male sex, older age, lower education, married or widowed status, and lower income. In the population with prior stroke, those with ALI ≥ 3 had 2.7 times higher adjusted all-cause mortality (HR: 2.7, CI: 1.5 - 4.9, p-value: 0.01) and 4.5 times higher adjusted cardiovascular mortality (HR: 4.5, CI: 1.4-14.3, p-value: 0.01) compared to those with ALI ≤1. In the general population, the ALI ≥ 3 group had 1.8 times higher adjusted stroke mortality (HR: 1.8, CI: 1.0-3.1, p-value: 0.04).

Conclusions Baseline higher allostatic load is associated with greater all-cause and cardiovascular mortality in stroke survivors, in addition to greater stroke mortality in stroke survivors and within the general population. This study highlights the importance of developing interventions to address stress after stroke.

Authors/Disclosures
Nicole C. Johnson, MD (Harbor UCLA) PRESENTER	Dr. Johnson has nothing to disclose.
Erica M. Jones, MD, MPH (UT Southwestern Medical Center)	The institution of Dr. Jones has received research support from NIH KL2.
Bruce I. Ovbiagele, MD, MSc, FAAN (San Francisco VA)	Dr. Ovbiagele has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Stroke Association. Dr. Ovbiagele has received research support from National Institutes of Health. Dr. Ovbiagele has a non-compensated relationship as a President with Society for Equity Neuroscience that is relevant to AAN interests or activities. Dr. Ovbiagele has a non-compensated relationship as a Board Member with World Stroke Organization that is relevant to AAN interests or activities.
Daniela Markovic (UCLA)	Daniela Markovic has nothing to disclose.
Amy T. Towfighi, MD	Dr. Towfighi has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law firms. The institution of Dr. Towfighi has received research support from NIH.

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