. 2021 Jul 30;7:100. doi: 10.1038/s41523-021-00309-6

Table 1.

Summary of studies including Black breast cancer patients and allostatic load (AL) biomarkers.

Refs.	N	Study design and subjects	AL biomarkers with cut-offs for AL determination	Composite AL score cut-offs	Key findings
Parente et al.²³	4875	Cross-sectional; Black and White women, ages 35–85	1. Systolic blood pressure ≥140 mmHg 2. Diastolic blood pressure ≥90 mmHg 3. Heart rate ≥90 beats; per minute 4. Total cholesterol level ≥240 mg/dL 5. High-density lipoprotein cholesterol <50 mg/dL 6. Body mass index ≥30 kg/m² 7. Glycosylated hemoglobin ≥6.4% 8. C-reactive protein >3 mg/L 9. Albumin <4 g/dL.	Low Al ≤3, High AL ≥4	A history of breast cancer was associated with elevated AL among Black women but not their white counterparts, adjusting for age, income, education, insurance type, and smoking history.
Xing et al.^24,25^a	AL Lipid 229 AL Inflammatory 409	Cross-sectional; Black women, ages 20–75	Lipid profile: 1. Systolic blood pressure ≥140 mmHg; 2. Diastolic blood pressure ≥90 mmHg 3. Waist circumference ≥88 cm 4. Glucose level ≥110 mg/dL 5. HDL <50 mg/dL 6. Total cholesterol >240 mg/dL or total cholesterol ≤240 mg/dL and LDL >130 mg/dL 7. Triglycerides ≥150 mg/dL 8. Ever use of medications to control hypertension, diabetes, or hypercholesterolemia Inflammatory profile: 1. Systolic blood pressure ≥140 mmHg; 2. Diastolic blood pressure ≥90 mmHg 3. Waist circumference ≥88 cm 4. Glucose level ≥110 mg/dL 5. HDL <50 mg/dL 6. Total cholesterol >240 mg/dL or total cholesterol ≤240 mg/dL and LDL >130 mg/dL 7. Triglycerides ≥150 mg/dL 8. Ever use of medications to control hypertension, diabetes, or hypercholesterolemia 9. eGFR <59 mL/min 10. Albumin <4 g/dL 11. BMI _30 kg/m²	Low Al ≤3, High AL ≥4	High pre-diagnostic AL, calculated by the lipid and inflammatory profiles, was associated with higher tumor grade. Elevated AL, calculated by the inflammatory profile, was associated with a larger tumor size. Elevated pre-diagnostic AL, calculated by inflammatory profile, associated with lower scores on the Functional Assessment of Cancer Therapy-General (FACT-G) survey and the functional well-being subscale assessed by the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) survey.
Zhao et al.¹⁶	934	Cross-sectional: Black and White women, aged 20–60+	1. SBP ≥140 mmHg 2. DBP ≥90 mmHg 3. HDL <50 mg/dL 4. Total cholesterol >240 mg/dL or total cholesterol ≥240 mg/dL 5. LDL >130 mg/dL 6. Triglycerides ≥150 mg/dL 7. Waist circumference ≥88 cm 8. BMI ≥30 kg/m² 9. Glucose level ≥110 mg/dL 10. HbA1C >6.5 11. Albumin <4 g/dL 12. CRP >3 mg/L 13. IL-6 >1.8 pg/mL 14. eGFR <60 mL/min/1.73m²; (14) 15. Creatinine >1.2 mg/dL 16. RHR >100 bpm 17. Previously taking medications to control metabolic diseases and hypertension	Low AL, 0–8 High AL, 9–16	AL was higher in Black and Hispanic patients compared to White patients AL was high in Black patients after adjusting for age at diagnosis, marital status, education, smoking status, alcohol status, physical activity, and tumor stage. There was an association between high AL and poorly differentiated tumors across all study races and ethnicities. In Black patients, there was an association between high AL and estrogen receptor negative tumors.

Refs.

Study design and subjects

AL biomarkers with cut-offs for AL determination

Composite AL score cut-offs

Key findings

Parente et al.²³

4875

Cross-sectional; Black and White women, ages 35–85

1. Systolic blood pressure ≥140 mmHg

2. Diastolic blood pressure ≥90 mmHg

3. Heart rate ≥90 beats; per minute

4. Total cholesterol level ≥240 mg/dL

5. High-density lipoprotein cholesterol <50 mg/dL

6. Body mass index ≥30 kg/m²

7. Glycosylated hemoglobin ≥6.4%

8. C-reactive protein >3 mg/L

9. Albumin <4 g/dL.

Low Al ≤3, High AL ≥4

A history of breast cancer was associated with elevated AL among Black women but not their white counterparts, adjusting for age, income, education, insurance type, and smoking history.

Xing et al.^24,25^a

AL Lipid 229

AL Inflammatory 409

Cross-sectional; Black women, ages 20–75

Lipid profile:

1. Systolic blood pressure ≥140 mmHg;

2. Diastolic blood pressure ≥90 mmHg

3. Waist circumference ≥88 cm

4. Glucose level ≥110 mg/dL

5. HDL <50 mg/dL

6. Total cholesterol >240 mg/dL or total cholesterol ≤240 mg/dL and LDL >130 mg/dL

7. Triglycerides ≥150 mg/dL

8. Ever use of medications to control hypertension, diabetes, or hypercholesterolemia

Inflammatory profile:

1. Systolic blood pressure ≥140 mmHg;

2. Diastolic blood pressure ≥90 mmHg

3. Waist circumference ≥88 cm

4. Glucose level ≥110 mg/dL

5. HDL <50 mg/dL

6. Total cholesterol >240 mg/dL or total cholesterol ≤240 mg/dL and LDL >130 mg/dL

7. Triglycerides ≥150 mg/dL

8. Ever use of medications to control hypertension, diabetes, or hypercholesterolemia

9. eGFR <59 mL/min

10. Albumin <4 g/dL

11. BMI _30 kg/m²

Low Al ≤3, High AL ≥4

High pre-diagnostic AL, calculated by the lipid and inflammatory profiles, was associated with higher tumor grade.

Elevated AL, calculated by the inflammatory profile, was associated with a larger tumor size.

Elevated pre-diagnostic AL, calculated by inflammatory profile, associated with lower scores on the Functional Assessment of Cancer Therapy-General (FACT-G) survey and the functional well-being subscale assessed by the Functional Assessment of Cancer Therapy-Breast

Cancer (FACT-B) survey.

Zhao et al.¹⁶

934

Cross-sectional: Black and White women, aged 20–60+

1. SBP ≥140 mmHg

2. DBP ≥90 mmHg

3. HDL <50 mg/dL

4. Total cholesterol >240 mg/dL or total cholesterol ≥240 mg/dL

5. LDL >130 mg/dL

6. Triglycerides ≥150 mg/dL

7. Waist circumference ≥88 cm

8. BMI ≥30 kg/m²

9. Glucose level ≥110 mg/dL

10. HbA1C >6.5

11. Albumin <4 g/dL

12. CRP >3 mg/L

13. IL-6 >1.8 pg/mL

14. eGFR <60 mL/min/1.73m²; (14)

15. Creatinine >1.2 mg/dL

16. RHR >100 bpm

17. Previously taking medications to control metabolic diseases and hypertension

Low AL, 0–8 High AL, 9–16

AL was higher in Black and Hispanic patients compared to White patients

AL was high in Black patients after adjusting for age at diagnosis, marital status, education, smoking status, alcohol status, physical activity, and tumor stage.

There was an association between high AL and poorly differentiated tumors across all study races and ethnicities.

In Black patients, there was an association between high AL and estrogen receptor negative tumors.

^aThis summarizes two articles by Xing et al.