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.
BACKGROUND
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.


METHODS
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).


METHODS
We measured fasting morning plasma cortisol.


METHODS
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.
Reynolds
Rebecca M
RM
Endocrinology Unit, Centre for Cardiovascular Science, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom. R.Reynolds@ed.ac.uk
Labad
Javier
J
Strachan
Mark W J
MW
Braun
Anke
A
Fowkes
F Gerry R
FG
Lee
Amanda J
AJ
Frier
Brian M
BM
Seckl
Jonathan R
JR
Walker
Brian R
BR
Price
Jackie F
JF
D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000886:Anthropometry; D002318:Cardiovascular Diseases / Q000453:epidemiology; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D005006:Ethnicity; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000453:epidemiology; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors
D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D006854:Hydrocortisone