Cortisol levels and history of depression in acute coronary syndrome patients

Abstract

BackgroundDepressed mood following an acute coronary syndrome (ACS) is a risk factor for future cardiac morbidity. Hypothalamic–pituitary–adrenal (HPA) axis dysregulation is associated with depression, and may be a process through which depressive symptoms influence later cardiac health. Additionally, a history of depression predicts depressive symptoms in the weeks following ACS. The purpose of this study was to determine whether a history of depression and/or current depression are associated with the HPA axis dysregulation following ACS.MethodA total of 152 cardiac patients completed a structured diagnostic interview, a standardized depression questionnaire and a cortisol profile over the day, 3 weeks after an ACS. Cortisol was analysed using: the cortisol awakening response (CAR), total cortisol output estimated using the area under the curve method, and the slope of cortisol decline over the day.ResultsTotal cortisol output was positively associated with history of depression, after adjustment for age, gender, marital status, ethnicity, smoking status, body mass index (BMI), Global Registry of Acute Cardiac Events (GRACE) risk score, days in hospital, medication with statins and antiplatelet compounds, and current depression score. Men with clinically diagnosed depression after ACS showed a blunted CAR, but the CAR was not related to a history of depression.ConclusionsPatients with a history of depression showed increased total cortisol output, but this is unlikely to be responsible for associations between depression after ACS and later cardiac morbidity. However, the blunted CAR in patients with severe depression following ACS indicates that HPA dysregulation is present.

Depressive Symptoms Are Associated with Mental Stress-Induced Myocardial Ischemia after Acute Myocardial Infarction

“…Potential mechanisms that might be invoked to explain the association between depressive symptoms and mental stress-induced myocardial ischemia include downstream physiologic effects of stress-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis, which can be dysregulated in depression [33]. Furthermore, inflammation, which is enhanced in depression, may be implicated.…”

Prospective Association of Morning Salivary Cortisol with Depressive Symptoms in Mid-Life: A Life-Course Study

“…Associations between low basal cortisol and depression have been reported elsewhere. For example, in 152 (133 men) patients who had survived an acute coronary episode, blunted cortisol awakening response was associated with current depression, taking account of previous depression and other factors[ 44 ].…”

Depressed or Not Depressed: Untangling Symptoms of Depression in Patients Hospitalized With Coronary Heart Disease

“…The percentages of patients with and without depression who had histories of depression were within the wide range (27%-67%) reported in other studies. [34][35][36][37] Further study is needed to asssess the differences in cognitive/affective symptoms of depression in ACs patients compared with chronic CHD patients and the relationship of a history of depression to the rate of depression in both populations.…”