title: Cortisol levels and history of depression in acute coronary syndrome patients.
abstract: BACKGROUND
  Depressed mood following an acute coronary syndrome (ACS) is a risk factor for future cardiac morbidity. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is associated with depression, and may be a process through which depressive symptoms influence later cardiac health. Additionally, a history of depression predicts depressive symptoms in the weeks following ACS. The purpose of this study was to determine whether a history of depression and/or current depression are associated with the HPA axis dysregulation following ACS.
  
  
  METHODS
  A total of 152 cardiac patients completed a structured diagnostic interview, a standardized depression questionnaire and a cortisol profile over the day, 3 weeks after an ACS. Cortisol was analysed using: the cortisol awakening response (CAR), total cortisol output estimated using the area under the curve method, and the slope of cortisol decline over the day.
  
  
  RESULTS
  Total cortisol output was positively associated with history of depression, after adjustment for age, gender, marital status, ethnicity, smoking status, body mass index (BMI), Global Registry of Acute Cardiac Events (GRACE) risk score, days in hospital, medication with statins and antiplatelet compounds, and current depression score. Men with clinically diagnosed depression after ACS showed a blunted CAR, but the CAR was not related to a history of depression.
  
  
  CONCLUSIONS
  Patients with a history of depression showed increased total cortisol output, but this is unlikely to be responsible for associations between depression after ACS and later cardiac morbidity. However, the blunted CAR in patients with severe depression following ACS indicates that HPA dysregulation is present.
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK. nadine.messerli@psy.unibe.ch
authors.forename: N
authors.initials: N
authors.lastname: Messerli-Bürgy
authors.forename: G J
authors.initials: GJ
authors.lastname: Molloy
authors.forename: A
authors.initials: A
authors.lastname: Wikman
authors.forename: L
authors.initials: L
authors.lastname: Perkins-Porras
authors.forename: G
authors.initials: G
authors.lastname: Randall
authors.forename: A
authors.initials: A
authors.lastname: Steptoe
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000378:metabolism* / Q000523:psychology; D000368:Aged; D003863:Depression / Q000150:complications / Q000378:metabolism*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry; D011795:Surveys and Questionnaires
chemical_list: D006854:Hydrocortisone