Elevated Fasting Plasma Cortisol Is Associated with Ischemic Heart Disease and Its Risk Factors in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study

Abstract

The previously described associations between HPA axis activation and features of the metabolic syndrome are present among people with type 2 diabetes. Elevated plasma cortisol is also associated with a greater prevalence of ischemic heart disease, independent of conventional risk factors. Understanding the role of cortisol in the pathogenesis of ischemic heart disease merits further exploration.

Hyperactivity of the hypothalamic-pituitary-adrenal axis in patients with type 2 diabetes and relations with insulin resistance and chronic complications

“…Fraser et al [27] demonstrated that in general population cortisol excretion rate Results are standardized β coefficients and significance, adjusted R 2 , and significance of model AUC area under the curve *p < 0.05, † p < 0.01, ‡ p < 0.001, § p < 0.0001, ¶ p < 0.00001 did not correlate with blood pressure but correlated strongly with BMI, WHR, and negatively with HDL cholesterol [27]. In The Edinburgh Type 2 Diabetes Study in type 2 diabetic patients, elevated fasting cortisol was associated with ischemic heart disease and its risk factors [28]. We can speculate that hyperinsulinemia and insulin resistance commonly observed in abdominal obesity can increase the HPA axis activity, but when overt type 2 diabetes develops, even without complications, the HPA axis is clearly hyperactive.…”

Changes in the Maternal Hypothalamic-Pituitary-Adrenal Axis in Pregnancy and Postpartum: Influences on Maternal and Fetal Outcomes

“…Similarly, follow-up of women exposed to extreme stress in pregnancy indicate these women are at increased risk of adverse mental health [121] . In the non-pregnant state, activation of the HPA axis increases the risk of metabolic and psychiatric disease [8,[122][123][124][125][126][127][128][129][130] . Preliminary evidence that altered HPA responses to pregnancy may influence later maternal mental health comes from a small study showing that increased cortisol responses to a standardized psychosocial stress test during healthy pregnancy predict postpartum depressive symptoms [131] .…”

Pathogenetic and Clinical Peculiarities of Metabolic Syndrome, Due to Obesity and Their Prognostic Value

“…Проблема метаболічних порушень у клініці посідає одне з ведучих місць [1,7,10,12]. Особливо привертає увагу розвиток метаболічного синдрому(МС) при ожирінні, оскільки, як фактор ризику, трапляється в першу чергу при ішемічній ( вінцевій ) хворобі серця, цукровому діабеті і низці інших патологій [4,5,10]. На даний час вивченню патогенезу МС присвячена велика кількість дослі-джень як в експерименті, так і в клініці [2,3,11].…”