title: Allostasis and allostatic load: expanding the discourse on stress and cardiovascular disease.
abstract: OBJECTIVE
  The aim of this discursive paper is to introduce allostasis and allostatic load, which are relatively new concepts proposed to explain physiological responses to stress, and to suggest ways in which allostasis theory can be applied to the development of clinical interventions to increase resilience for producing better health outcome.
  
  
  BACKGROUND
  Common explanations of stress have failed adequately to explicate its association with health and chronic illness. Allostasis is the extension of the concept of homeostasis and represents the adaptation process of the complex physiological system to physical, psychosocial and environmental challenges or stress. Allostatic load is the long-term result of failed adaptation or allostasis, resulting in pathology and chronic illness.
  
  
  CONCLUSIONS
  The concepts of allostasis and allostatic load introduced the idea that external challenges initiate allostasis and chronic stress causes allostatic load that can be measured with multiple biomarkers. Finding from several studies suggests that higher allostatic load is associated with worse health outcomes. Resilience represents successful allostasis and strategies can be implemented to enhance resilience and thereby improve health outcomes.
  
  
  CONCLUSIONS
  This theoretical model provides a comprehensive explanation of the human body's adaptation processes in response to stress and the results of failed adaptation over time. In addition, combining the concepts of allostasis and resilience may help us to understand and implement clinical strategies better to reduce or prevent the debilitating physiological and psychological effects of chronic stress and chronic illness.
  
  
  CONCLUSIONS
  Clinical practice should be based on a solid theoretical foundation to improve health outcomes. Strategies to manage stress and increase resilience along with clinical interventions to manage the physiological responses to chronic stress are necessary to assist in preventing and controlling the detrimental effects of chronic disease on human life.
authors.affiliation: School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA. gang@email.unc.edu
authors.forename: Jeongok G
authors.initials: JG
authors.lastname: Logan
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Barksdale
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000223:Adaptation, Psychological / Q000502:physiology*; D052636:Allostasis / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D002908:Chronic Disease; D017281:Cost of Illness; D054624:Health Status Disparities; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D008016:Life Change Events; D008019:Life Style; D008954:Models, Biological; D008960:Models, Psychological; D010913:Pituitary-Adrenal System / Q000502:physiology; D018570:Risk Assessment; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D013997:Time Factors