Associations of Serum Cortisol with Cardiovascular Risk and Mortality in Patients Referred to Coronary Angiography

Abstract

Context Serum cortisol may be associated with cardiovascular risk factors and mortality in patients undergoing coronary angiography, but previous data on this topic are limited and controversial. Objective We evaluated whether morning serum cortisol is associated with cardiovascular risk factors, lymphocyte subtypes and mortality. Design and Setting This is a prospective cohort study performed at a tertiary care centre in south-west Germany between 1997 and 2000. Participants We included 3052 study participants who underwent coronary angiography. Main Outcome Measures Primary outcome measures were cardiovascular risk factors, lymphocyte subtypes and all-cause and cardiovascular mortality. Results Serum cortisol was associated with an adverse cardiovascular risk profile, but there was no significant association with coronary artery disease or acute coronary syndrome. In a subsample of 2107 participants, serum cortisol was positively associated with certain lymphocyte subsets including CD16+CD56+ (natural killer) cells (p<0.001). Comparing the fourth versus the first serum cortisol quartile, the crude Cox proportional hazard ratios (with 95% confidence intervals) were 1.22 (1.00 to 1.47) for all-cause and 1.32 (1.04 to 1.67) for cardiovascular mortality, respectively. After adjustments for various cardiovascular risk factors, these associations were attenuated to 0.93 (0.76 to 1.14) for all-cause, and 0.97 (0.76 to 1.25) for cardiovascular mortality, respectively. Conclusions Despite significant associations with classic cardiovascular risk factors and natural killer cells, serum cortisol was no significant and independent predictor of mortality in patients referred to coronary angiography. These findings might reflect that adverse cardiovascular effects of cortisol could be counterbalanced by some cardiovascular protective actions.

Correlation Between Increasing DNA Copy Numbers That Encode Cortisol Biosynthesis Enzymes and Myocardial Infarction Patients

“…Almost all smaller crosssectional studies 23,24 have found that patients with AMI had elevated cortisol levels, which increase the risk of fatality and morbidity. Additionally, 25,26 showed a correlation between incident cardiovascular disease (CVD) and plasma cortisol, and such results imply that higher morning cortisol is a causative risk factor for CVD.…”

Adrenal Abcg1 Controls Cholesterol Flux and Steroidogenesis

“…However, steroidogenic capacity in these individuals has not been assessed. Given the association between higher serum cortisol concentrations and cardiovascular risk profile ( 61 ), it would be of interest to assess basal and stimulated glucocorticoid levels in individuals carrying these alleles, which might explain interindividual variability in basal cortisol or physiological cortisol responses, and excess cortisol levels in individuals carrying risk alleles.…”

By what molecular mechanisms do social determinants impact cardiometabolic risk?

“…Similarly, there have been numerous reports of cortisol associating with CVD and CVD risk factors. In a prospective cohort study performed at a tertiary care center with 3052 participants who underwent coronary angiography, increased morning serum cortisol was associated with adverse cardiovascular risk factors including elevated systolic blood pressure, higher fasting glucose, increased triglycerides, and lower glomerular filtration rate [ 59 ]. In this study, increased cortisol also associated with higher counts of CD16+CD56+ (NK cells) and CD3+CD8+ (T-suppressor) cells.…”