Endothelial activation and stress index in disease outcomes: associations with cardiovascular disease prevalence and mortality in cancer patients

To investigate the association between the endothelial activation and stress index (EASIX) and cardiovascular disease (CVD) prevalence and mortality among cancer patients. Data from 10 NHANES cycles (1999–2018) were analyzed using two complementary frameworks: [1] a cross-sectional analysis examining the association between EASIX and CVD prevalence among cancer patients, and [2] a longitudinal survival analysis evaluating the association between baseline EASIX and subsequent all-cause and CVD-specific mortality in cancer patients with pre-existing CVD. Weighted multivariable logistic regression was used for the cross-sectional analysis. For the longitudinal analysis, Kaplan–Meier analysis, weighted Cox proportional hazards models, restricted cubic spline analysis, two-piecewise Cox models, subgroup analysis, conditional survival analysis, and Fine–Gray competing risk models were performed. In the cross-sectional analysis, higher EASIX was associated with greater CVD prevalence among cancer patients (OR = 1.69, 95% CI: 1.30–2.20). In the longitudinal analysis of cancer patients with pre-existing CVD, elevated EASIX was associated with higher risks of all-cause mortality (HR = 1.87, 95% CI: 1.36–2.58) and CVD-specific mortality (HR = 2.15, 95% CI: 1.40–3.29) during follow-up. These associations remained consistent across restricted cubic spline analyses, two-piecewise Cox models, subgroup analyses, conditional survival analyses, and Fine–Gray competing risk models. Higher EASIX was associated with greater CVD prevalence among cancer patients and increased risks of all-cause and CVD-specific mortality among those with pre-existing CVD. EASIX may serve as a marker of cardiovascular burden and a prognostic indicator of mortality risk in this population.