Allostatic load in incident airflow obstruction: Evidence for syndemics?

<bold>Introduction:</bold> A systemic paradigm shift is hypothesised in the transition of COPD as a single disease with comorbidities to COPD as part of a multimorbid state. Allostatic load (ALLO) is ability to cope with stressors, considering interactions among physiological systems. <bold>Objectives:</bold> The current study analysed differences in AL between adults with incident and persistent airflow obstruction (AO). <bold>Methods:</bold> Data from the baseline and follow up visits (mean assessment interval: 4.1 yrs) of Lung hEart sociAl boDy (LEAD) Austrian cohort were used. AO was defined by post-BD FEV1/FVC<0.7. Participants with persistent AO or transitioning to AO from normal status were identified. ALLO was calculated using 13 biomarkers. The at-risk range was defined as the highest age-specific quartile of systolic and diastolic blood pressure, pulse wave velocity, HbA1c, cholesterol, triglycerides, CRP, fat mass index, and visceral adipose tissue, and the lowest quartile of high-density lipoprotein, glomerular filtration rate, bone density, and appendicular lean mass index. Participants scored 1 point per at-risk marker and 1 for medication for hypertension, diabetes, and dyslipidaemia. Total points constituted ALLO. Comparison of ALLO between persistent and incident case of AO was made using a generalized linear model, controlling for age, sex, and smoking status. <bold>Results:</bold> The mean±SD ALLO at visit 1, visit 2, and Δ ALLO were 4.0±2.3, 4.1±2.2, and 0.23±1.7 for 410 persistent, and 3.6±2.3, 3.9±2.2, and 0.36±1.7 for 352 incident cases of AO, respectively (P>0.05). None of the components of ALLO were statistically different between these 2 groups. <bold>Conclusion:</bold> A syndemic occurrence could not be confirmed in the current study.