Cortisol awakening response is elevated in acute coronary syndrome patients with type-D personality.
OBJECTIVE
Type-D or "distressed" personality and depression following admission for acute coronary syndrome (ACS) have been associated with poor clinical outcome. The biological pathways underpinning this relationship may include disruption of the hypothalamic-pituitary-adrenocortical (HPA) axis. We therefore assessed cortisol output in patients who had recently suffered from ACS.


METHODS
Salivary cortisol was assessed eight times over a 24-h period in 72 patients within 5 days of admission for ACS. Depressive symptoms were measured with the Beck Depression Inventory (BDI), and type-D personality was measured with the Type-D Scale-16. Particular attention was given to cortisol awakening response (CAR), which was measured as the difference in cortisol between waking and peak responses 15-30 min later.


RESULTS
Cortisol showed a typical diurnal pattern, with low levels in the evening, high levels early in the day, and CAR averaging 7.58+/-10.0 nmol/l. Cortisol was not related to the severity of ACS or underlying coronary artery disease or to BDI scores. The CAR was positively associated with type-D personality independently of age, gender, and body mass (P=.007). Linear regression showed that type-D personality accounted for 7.9% of the variance in CAR after age, sex, body mass, BDI, cortisol level on waking, and fatigue had been taken into account (P=.008).


CONCLUSIONS
Type-D personality may be associated with disruption of HPA axis function in survivors of acute cardiac events and may contribute to heightened inflammatory responses influencing future cardiac morbidity.
Whitehead
Daisy L
DL
Department of Epidemiology and Public Health, Psychobiology Group, University College London, London, United Kingdom.
Perkins-Porras
Linda
L
Strike
Philip C
PC
Magid
Kesson
K
Steptoe
Andrew
A
D000328:Adult; D000368:Aged; D001143:Arousal / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology; D003327:Coronary Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D010555:Personality Inventory; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012463:Saliva / Q000378:metabolism; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013577:Syndrome; D014851:Wakefulness / Q000502:physiology*
D006854:Hydrocortisone