Introduction
Allostatic load, a measure of stress-related physiologic dysregulation, is associated
with numerous mortality risk factors. This systematic review and meta-analysis examines
the relationship between high allostatic load (i.e., increased dysregulation versus
low dysregulation) and mortality (cardiovascular disease and all-cause mortality).
Methods
Systematic searches of 2 databases conducted in May 2021 yielded 336 unique records;
17 eligible studies (2001–2020) were included.
Results
High allostatic load was associated with increased risk of all-cause mortality across
all the 17 individual studies (hazard ratio=1.08–2.75) and in 6 of 8 studies examining
cardiovascular disease mortality (hazard ratio=1.19−3.06). Meta-analyses indicated
that high allostatic load was associated with increased risk of all-cause mortality,
overall (hazard ratio=1.22, 95% CI=1.14, 1.30, n=10) and across subgroups (hazard ratio=1.11−1.41), and similarly for cardiovascular
disease mortality (hazard ratio=1.31, 95% CI=1.10, 1.57, n=6). Although studies were generally of good quality (n=13), heterogeneity was high in most pooled estimates (I2>90%).
Discussion
In this review of relatively good-quality studies, high allostatic load was associated
with an increased mortality risk of 22% for all-cause mortality and 31% for cardiovascular
disease mortality. Thus, allostatic load is an emerging and potent modifiable risk
factor for all-cause and cardiovascular disease mortality that shows promise as a
prognostic indicator for mortality. The heterogeneity in allostatic load assessment
across studies highlights the need for standardized measurement. The findings underscore
the importance of allostatic load's dynamic nature, which may be especially relevant
for mitigating mortality risk in younger adults. Because older adults are oversampled,
future allostatic load research should prioritize younger adults and longitudinal
monitoring and specific cardiovascular disease mortality risk associations and individualize
behavioral and lifestyle targets for reducing allostatic load.
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Publication History
Published online: April 04, 2022
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
