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
RM Reynolds, J Labad, MWJ Strachan… - The Journal of …, 2010 - academic.oup.com
The Journal of Clinical Endocrinology & Metabolism, 2010•academic.oup.com
Context: Increased activity of the hypothalamic-pituitary-adrenal (HPA) axis may underlie the
metabolic syndrome, but whether circulating cortisol levels predict cardiovascular end points
is less clear. People with type 2 diabetes are at increased cardiovascular disease risk and
thus are suitable to study associations of plasma cortisol with cardiovascular risk. Objective:
We aimed to assess whether altered HPA axis activity was associated with features of the
metabolic syndrome and ischemic heart disease in people with type 2 diabetes. Design and …
metabolic syndrome, but whether circulating cortisol levels predict cardiovascular end points
is less clear. People with type 2 diabetes are at increased cardiovascular disease risk and
thus are suitable to study associations of plasma cortisol with cardiovascular risk. Objective:
We aimed to assess whether altered HPA axis activity was associated with features of the
metabolic syndrome and ischemic heart disease in people with type 2 diabetes. Design and …
Abstract
Context: Increased activity of the hypothalamic-pituitary-adrenal (HPA) axis may underlie the metabolic syndrome, but whether circulating cortisol levels predict cardiovascular end points is less clear. People with type 2 diabetes are at increased cardiovascular disease risk and thus are suitable to study associations of plasma cortisol with cardiovascular risk.
Objective: We aimed to assess whether altered HPA axis activity was associated with features of the metabolic syndrome and ischemic heart disease in people with type 2 diabetes.
Design and Setting: We conducted a cross-sectional cohort study in the general community, including 919 men and women aged 67.9 (4.2) yr with type 2 diabetes (the Edinburgh Type 2 Diabetes Study).
Intervention: We measured fasting morning plasma cortisol.
Main Outcome Measurement: Associations between cortisol levels, features of the metabolic syndrome, obesity, and ischemic heart disease were determined.
Results: Elevated plasma cortisol levels were associated with raised fasting glucose and total cholesterol levels (P < 0.001). These findings remained significant after adjustment for potential confounding factors (P < 0.001). Elevated cortisol levels were associated with prevalent ischemic heart disease (>800 vs. <600 nmol/liter; odds ratio, 1.58; P = 0.02). This association remained significant after adjustment for duration and control of diabetes and other cardiovascular risk factors (P = 0.03).
Conclusions: 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.
Oxford University Press