QJM Advance Access originally published online on May 20, 2009
QJM 2009 102(7):469-475; doi:10.1093/qjmed/hcp057
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Circulating plasma cortisol concentrations are not associated with coronary artery disease or peripheral vascular disease
From the 1Centre for Cardiovascular Sciences, University of Edinburgh, Queen's Medical Research Institute and 2Division of Community Health Sciences and Centre for Public Health and Primary Care Research, University of Edinburgh, Edinburgh, Scotland, UK
Address correspondence to Dr R. Reynolds, Endocrinology Unit, Centre for Cardiovascular Sciences, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, Scotland, UK. email: R.Reynolds{at}ed.ac.uk
Received 16 December 2008 and in revised form 23 April 2009
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Abstract |
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Background: Although the prevalence of cardiovascular disease is declining, the obesity epidemic with associated metabolic syndrome may reverse this trend. Hypothalamic–pituitary–adrenal (HPA) axis activation may underlie the metabolic syndrome, but whether circulating cortisol levels predict vascular disease is less clear. A recent study reported a positive correlation between cortisol levels measured prior to coronary angiography and disease severity, but others have not demonstrated such a relationship. This may be due to different sampling conditions, reflecting basal cortisol levels, vs. responsiveness of HPA axis activity, which may have diverse influences on the pathogenesis of atherosclerosis.
Aims: To determine whether basal circulating cortisol levels predict coronary artery (CAD) or peripheral vascular disease.
Methods: Basal plasma cortisol levels were measured in 278 subjects with suspected CAD, who had undergone elective coronary angiography and in 76 cases and 85 controls with and without peripheral vascular disease, respectively.
Results: After adjustment for potential confounding factors, circulating cortisol levels tended to be lower in those with confirmed coronary vessel disease at angiography (P = 0.10), and in those requiring intervention following angiography (P = 0.07). Lower cortisol levels also predicted those with more symptoms of angina (P = 0.01). Cortisol levels were no different in those with or without peripheral vascular disease.
Conclusion: A single measurement of circulating cortisol is a poor predictor of vascular disease. More detailed characterization of the HPA axis is necessary to determine the role of circulating endogenous glucocorticoids and their responsiveness to stress in atherosclerosis.