title: High long-term cortisol levels, measured in scalp hair, are associated with a history of cardiovascular disease.
abstract: BACKGROUND
  Stress is associated with an increased incidence of cardiovascular disease. The impact of chronic stress on cardiovascular risk has been studied by measuring cortisol in serum and saliva, which are measurements of only 1 time point. These studies yielded inconclusive results. The measurement of cortisol in scalp hair is a novel method that provides the opportunity to measure long-term cortisol exposure. Our aim was to study whether long-term cortisol levels, measured in scalp hair, are associated with cardiovascular diseases.
  
  
  METHODS
  A group of 283 community-dwelling elderly participants were randomly selected from a large population-based cohort study (median age, 75 y; range, 65-85 y). Cortisol was measured in 3-cm hair segments, corresponding roughly with a period of 3 months. Self-reported data concerning coronary heart disease, stroke, peripheral arterial disease, diabetes mellitus, and other chronic noncardiovascular diseases were collected.
  
  
  RESULTS
  Hair cortisol levels were significantly lower in women than in men (21.0 vs 26.3 pg/mg hair; P < .001). High hair cortisol levels were associated with an increased cardiovascular risk (odds ratio, 2.7; P = .01) and an increased risk of type 2 diabetes mellitus (odds ratio, 3.2; P = .04). There were no associations between hair cortisol levels and noncardiovascular diseases.
  
  
  CONCLUSIONS
  Elevated long-term cortisol levels are associated with a history of cardiovascular disease. The increased cardiovascular risk we found is equivalent to the effect of traditional cardiovascular risk factors, suggesting that long-term elevated cortisol may be an important cardiovascular risk factor.
authors.affiliation: Department of Internal Medicine, Erasmus MC, Room Ee-542, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. l.manenschijn@erasmusmc.nl
authors.forename: L
authors.initials: L
authors.lastname: Manenschijn
authors.forename: L
authors.initials: L
authors.lastname: Schaap
authors.forename: N M
authors.initials: NM
authors.lastname: van Schoor
authors.forename: S
authors.initials: S
authors.lastname: van der Pas
authors.forename: G M E E
authors.initials: GM
authors.lastname: Peeters
authors.forename: P
authors.initials: P
authors.lastname: Lips
authors.forename: J W
authors.initials: JW
authors.lastname: Koper
authors.forename: E F C
authors.initials: EF
authors.lastname: van Rossum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D005260:Female; D006197:Hair / Q000254:growth & development / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D012535:Scalp; D057566:Self Report; D012727:Sex Characteristics; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000378:metabolism / Q000503:physiopathology*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone