Prospective associations of allostatic load with heart failure incidence and prognosis: findings from two national cohorts

Q: What are the key findings of this study?

High allostatic load was independently associated with a significantly increased risk of incident heart failure (OR 2.07) and elevated cardiovascular mortality (HR 2.03) compared to low allostatic load.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=5014). Intervention: High allostatic load vs. Low allostatic load. Primary outcome: Incident heart failure (OR 2.07, 95% CI 1.29-3.32, p=0.002).

Q: What does this research mean for the field?

High allostatic load is independently associated with a significantly increased risk of incident heart failure and elevated cardiovascular and all-cause mortality in heart failure patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

YuFan Nan; Haofeng Zhang; Fudong He; Lei Sun; Xiu Qin; Hua Xiao; Haidong Zhu; Yanbin Dong; Haiyan Chen; Guang Hao

doi:10.37349/ec.2026.1012118

August 13, 2026Exploration of CardiologyOpen Access

Prospective associations of allostatic load with heart failure incidence and prognosis: findings from two national cohorts

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Key result

High allostatic load linked to ~107% greater incident HF risk and elevated CV mortality.

OR 2.07
95% CI 1.29-3.32
P=0.002
n=5,014

Why the study?

Allostatic load is a composite measure of cumulative physiological stress, but its role in heart failure onset and prognosis remains unclear.

Does elevated allostatic load predict incident heart failure in the general population and increased mortality in patients with established heart failure?

Key Points

To evaluate the prospective associations of allostatic load, a cumulative measure of physiological stress, with incident heart failure and mortality outcomes.
Analyzed data from two prospective U.S. cohorts: 3,814 adults from the Health and Retirement Study (HRS, 2016–2020) and 1,200 heart failure patients from the National Health and Nutrition Examination Survey (NHANES, 1999–2010 and 2015–2016).
Derived allostatic load (AL) from nine biomarkers, categorizing participants into low (0–2), medium (3), or high (≥ 4) AL groups.
Used multivariable logistic regression to assess incident heart failure over ~4 years of follow-up in HRS, and Cox regression to examine cardiovascular and all-cause mortality over a median follow-up of 5.92 years in NHANES.
In the HRS cohort, high AL was associated with higher incident heart failure risk compared with low AL (OR = 2.07; 95% CI: 1.29–3.32; P = 0.002), with each 1-unit increase raising risk by 30% (OR = 1.30; 95% CI: 1.13–1.49; P < 0.001).
In heart failure patients from NHANES, high AL was associated with elevated cardiovascular mortality (HR = 2.03; 95% CI: 1.37–3.03; P < 0.001) and all-cause mortality (HR = 1.70; 95% CI: 1.30–2.22; P < 0.001) compared with low AL.
Each 1-unit increase in AL was associated with an 18% increase in cardiovascular mortality (HR = 1.18; 95% CI: 1.05–1.33; P = 0.007) and a 15% increase in all-cause mortality (HR = 1.15; 95% CI: 1.06–1.24; P = 0.001).

Study Design

Type

Cohort (n=5,014)

Structured PICO

Does elevated allostatic load predict incident heart failure in the general population and increased mortality in patients with established heart failure?

P

Population

5,014 adults from two U.S. national cohorts, including 3,814 without baseline heart failure followed for approximately 4 years and 1,200 with heart failure followed for a median of 5.9 years.

E

Exposure

High allostatic load (AL score ≥ 4), derived from nine biomarkers (systolic BP, diastolic BP, resting pulse, BMI, total cholesterol, HDL-C, HbA1c, albumin, and CRP)

C

Comparator

Low allostatic load (AL score 0-2)

O

Outcome

Incident heart failure (in the HRS cohort) and cardiovascular and all-cause mortality (in the NHANES cohort)hard clinical

Main Result

Odds Ratio: 2.07 (95% CI 1.29–3.32)

Absolute Event Rate: 9.8% vs 2.6%

p-value: p=0.002

Elevated allostatic load is an independent predictor of both new-onset heart failure in the general population and increased cardiovascular mortality in patients with established heart failure.

Limitations

Heart failure was based on self-report in the HRS cohort, which is susceptible to recall bias and misclassification.
Information on heart failure subtypes (e.g., HFrEF and HFpEF) was unavailable.
Observational study design cannot entirely exclude residual confounding or reverse causation.
Allostatic load was assessed only at baseline, preventing examination of longitudinal changes.
Potential for selection bias due to sample attrition and missing data.
Subgroup analysis findings should be considered exploratory because of the relatively limited sample size and statistical power.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May inform HF risk stratification without changing practice yet; leaves open trials targeting allostatic load.

Abstract

Aim: Allostatic load (AL) is a composite measure of cumulative physiological stress, but its role in heart failure (HF) onset and prognosis remains unclear. Methods: We analyzed data from two U.S. cohorts. Logistic regression assessed AL and incident HF in 3,814 adults from the Health and Retirement Study (HRS, 2016–2020). Cox regression examined AL with cardiovascular and all-cause mortality in 1,200 HF patients from the National Health and Nutrition Examination Survey (NHANES, 1999–2010 and 2015–2016). AL was derived from nine biomarkers and categorized as low (0–2), medium (3), or high (≥ 4). Results: In HRS, after full adjustment, high AL was associated with increased incident HF risk versus low AL (OR = 2.07; 95% CI: 1.29–3.32; P = 0.002), with each 1-unit increase raising risk by 30% (P < 0.001). In NHANES, after full adjustment, high AL predicted elevated cardiovascular (HR = 2.03; 95% CI: 1.37–3.03; P < 0.001) and all-cause mortality (HR = 1.70; 95% CI: 1.30–2.22; P < 0.001). Per unit increase, AL raised cardiovascular mortality by 18% and all-cause mortality by 15%. Model performance improved modestly with AL. Conclusions: Elevated AL is independently associated with HF incidence and poorer prognosis, supporting its potential as an integrative biomarker for HF risk stratification and prevention.

Discussion

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Cite This Study

Nan et al. (2026) conducted a cohort in Heart failure (n=5,014). High allostatic load vs. Low allostatic load was evaluated on Incident heart failure (OR 2.07, 95% CI 1.29-3.32, p=0.002). High allostatic load was independently associated with a significantly increased risk of incident heart failure (OR 2.07) and elevated cardiovascular mortality (HR 2.03) compared to low allostatic load.

synapsesocial.com/papers/6a801a2875c2e31742c86c13 https://doi.org/10.37349/ec.2026.1012118

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Prospective associations of allostatic load with heart failure incidence and prognosis: findings from two national cohorts

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prospective associations of allostatic load with heart failure incidence and prognosis: findings from two national cohorts

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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