Relation of morning serum cortisol to prothrombotic activity in women with stable coronary artery disease.
BACKGROUND
Increased circulating cortisol levels have been associated with severity of atherosclerosis. Low-grade systemic thrombogenicity plays a major role in the initiation and progression of coronary disease. We hypothesized a direct relationship between cortisol and hemostasis factors related to a prothrombotic state in coronary artery disease.


METHODS
We measured morning serum cortisol and activated clotting factor VII, fibrinogen, von Willebrand factor antigen, and plasminogen activator inhibitor-1 activity in 285 women (56 +/- 7 years) between 3 and 6 months after an acute coronary event. To test whether the relationship between cortisol and hemostasis factors would be independent, statistical adjustment was made for demographic, biomedical, life style, and psychosocial variables.


RESULTS
Higher serum cortisol levels predicted higher fibrinogen (beta = .17, P = .001) and higher von Willebrand factor (beta = .16, P = .008), all independently of covariates, including C-reactive protein, which was also an independent predictor of fibrinogen (beta = .20, P = .001) and von Willebrand factor (beta = .16, P = .004). Higher levels of vital exhaustion were associated with higher levels of activated clotting factor VII independently of covariates and depression (beta = .18, P = .045). Cortisol showed crude correlations with vital exhaustion (r = .14, P = .022) and with depression (r = .13, P = .043) but did not mediate the relationship between psychosocial variables and hemostatic factors.


CONCLUSIONS
Morning serum cortisol showed a modest but independent association with prothrombotic activity in women with coronary artery disease suggesting that increased cortisol levels might contribute to atherosclerosis via eliciting a hypercoagulable state.
von Känel
Roland
R
Department of General Internal Medicine, University Hospital, Berne 3010, Switzerland. roland.vonkaenel@insel.ch
Mausbach
Brent T
BT
Kudielka
Brigitte M
BM
Orth-Gomér
Kristina
K
D000328:Adult; D000368:Aged; D001779:Blood Coagulation Factors / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000097:blood* / Q000503:physiopathology / Q000523:psychology; D003863:Depression / Q000097:blood; D005260:Female; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D016014:Linear Models; D008875:Middle Aged
D001779:Blood Coagulation Factors; D002097:C-Reactive Protein; D006854:Hydrocortisone