title: Independent effects of obesity and cortisol in predicting cardiovascular risk factors in men and women.
abstract: OBJECTIVE
  Recent data suggest that higher plasma cortisol may be associated with hypertension and insulin resistance in otherwise healthy men, as it is in Cushing's syndrome. However, obesity in women is associated with lower plasma cortisol concentrations. This study sought to establish whether plasma cortisol is associated with cardiovascular risk factors in women as it is in men, and whether these relationships in either sex are confounded by obesity.
  
  
  METHODS
  A population-based cross-sectional study.
  
  
  METHODS
  The MONICA study in northern Sweden.
  
  
  METHODS
  From a target cohort of 2500, 1921 subjects took part and 226 were randomly selected because they attended between 07.00 and 09.00 h after an overnight fast. A 75 g oral glucose tolerance test was performed and blood sampled at baseline and 2 h after glucose.
  
  
  RESULTS
  Plasma cortisol was lower in relatively obese subjects: in men, this was observed only in the 2 h sample (r = -0.23, P = 0.02) and in women only in the fasting sample (r = -0.26, P < 0.01). Simple regression analysis did not identify relationships between plasma cortisol and blood pressure, serum lipids, fasting insulin or glucose tolerance. However, after adjusting for the effect of obesity by multiple regression, higher plasma cortisol was independently associated with higher diastolic blood pressure in men (r = 0.21, P = 0.04) but not in women, and higher fasting serum triglyceride levels in women (r = 0.28, P < 0. 001) but not in men.
  
  
  CONCLUSIONS
  Increasing obesity and plasma cortisol concentrations make independent and sex-specific contributions to variations in blood pressure and aspects of the insulin resistance syndrome. Adverse cardiovascular risk is greatest in those with the combination of obesity and failure to downregulate plasma cortisol levels.
authors.affiliation: University of Edinburgh, Department of Medicine, Western General Hospital, Edinburgh, UK. B.Walker@ed.ac.uk
authors.forename: B R
authors.initials: BR
authors.lastname: Walker
authors.forename: S
authors.initials: S
authors.lastname: Soderberg
authors.forename: B
authors.initials: B
authors.lastname: Lindahl
authors.forename: T
authors.initials: T
authors.lastname: Olsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology* / Q000503:physiopathology; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011237:Predictive Value of Tests; D011863:Radioimmunoassay; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D007328:Insulin; D014280:Triglycerides; D002784:Cholesterol; D006854:Hydrocortisone