Diurnal Cortisol Rhythm Is Associated With Adverse Cardiac Events and Mortality in Coronary Artery Bypass Patients

Abstract

Purpose:There is growing evidence that the hypothalamic-pituitary-adrenal axis plays a role in the progression of cardiovascular disease. We examined the relationship between diurnal cortisol rhythm and adverse events in patients undergoing coronary artery bypass graft (CABG) surgery. We hypothesized that a flatter presurgical diurnal cortisol slope would be associated with higher rates of adverse cardiac events and death in the years following the CABG procedure.Methods:Repeated measures of saliva were taken over the day from 250 CABG patients 1 month before surgery to assess diurnal cortisol slope and overall output (area under the curve). Long-term clinical outcomes were occurrence of a major adverse cardiac event (MACE) and death, and were collected up to 2.68 (SD = 0.40) years after surgery. Cox proportional hazard models were used to determine relationships between presurgical cortisol and clinical outcomes. EuroSCORE, chronic illness burden, and whether or not the patient had undergone cardiopulmonary bypass were included as covariates in the models.Results:Diurnal cortisol slope predicted the occurrence of MACE or death after surgery (hazard ratio = 0.73; 95% confidence interval = 0.56–0.96; P = .023). Patients with a steeper slope were at reduced risk of adverse outcomes. This association was driven by changes in both waking and evening cortisol levels.Conclusion:These results provide evidence for a link between diurnal cortisol rhythm and recovery after CABG. Measuring diurnal cortisol slope before surgery may help to identify those patients at risk of adverse outcomes in the years after the procedure.

Physiological stress measures in preschool children and their relationship with body composition and behavioral problems

“…(). Analyses of slope were chosen due to their predictive relevance of adverse physical health outcomes in clinical and nonclinical samples of adult populations (Kumari, Shipley, Stafford & Kivimaki, ; Matthews, Schwartz, Cohen & Seeman, ; Ronaldson et al., ). The peak value at 30 min after awakening was not integrated as the peak value, and the diurnal slopes are modulated by different neurobiological systems (Stalder et al., ).…”

“…Diurnal salivary decline or increase (i.e., cortisol and sAA slope) was calculated based on regression of the first sample and at least two other saliva samples over the day according to Saridjan et al (2014). Analyses of slope were chosen due to their predictive relevance of adverse physical health outcomes in clinical and nonclinical samples of adult populations (Kumari, Shipley, Stafford & Kivimaki, 2011;Matthews, Schwartz, Cohen & Seeman, 2006;Ronaldson et al, 2015). The peak value at 30 min after awakening was not integrated as the peak value, and the diurnal slopes are modulated by different neurobiological systems (Stalder et al, 2016).…”

Circadian Rhythm of Deaths in a Cardiology Department: A Five-Year Analysis

“…However, other studies have shown conflicting results [7,8], and there may be differences between the general population and patients with previous cardiovascular diseases [8]. It has been proposed that circadian rhythm in cortisol release [9] plays an important role in the high rate of cardiovascular events that has been observed during the first hours of the day [10], but there are other factors involved that could also have an important impact, such as the activation of the autonomic nervous system [4]. As hospitalized patients often have circadian rhythm disruptions, a variation in circadian patterns of death may occur.…”

Circadian Plasma Cortisol Measurements Reflect Severity of Hypercortisolemia in Children with Different Etiologies of Endogenous Cushing Syndrome

“…Hence, the current guidelines for CS diagnosis in adult patients cite late night hypercortisolemia as measured by midnight salivary cortisol as a criterion for CS diagnosis [4], and similar tests are used for CS diagnosis in children [5]. Moreover, beyond its use for CS diagnosis, diminished circadian cortisol variation is both a cardiovascular [6] and metabolic risk factor [7], even among normocortisolemic subjects.…”