title: The association between urinary cortisol excretion and cardiovascular risk factors, bone status and quality of life in the population.
abstract: OBJECTIVE
  Patients with glucocorticoid excess have increased cardiovascular risk, decreased bone mineral density and impaired quality of life (QoL). The aim of this study was to evaluate the association between urinary cortisol excretion and cardiovascular risk factors, bone status and QoL in the population. We hypothesized that higher cortisol excretion was associated with adverse cardiovascular risk profile, worse skeletal health and QoL.
  
  
  METHODS
  This was a cross-sectional study including a population sample (n=348), aged 38-77years. The mean age in women was 64.0±8.5years (n=276) and 60.3±10.2years in men (n=72). The metabolic syndrome, body composition measured with bioimpedance, calcaneal quantitative ultrasound, fractures and QoL evaluated with the Nottingham Health Profile, Psychological General Well-Being (PGWB) and the Short Form 36 (SF-36) were studied. Urinary free cortisol (UFC) was measured using radioimmunoassay.
  
  
  RESULTS
  UFC was higher in men (230±120nmol/L) compared to women (153±71; P<0.001) and decreased with increasing age (P<0.001). In a regression analysis, after adjustment for gender, age and body mass index, higher UFC was associated with higher fat-free mass (P<0.01), favourable calcaneal bone measurements (P<0.05), better general health measured with PGWB (P<0.01) and SF-36 (P=0.001) and tended to be negatively associated with the metabolic syndrome (P=0.07).
  
  
  CONCLUSIONS
  In contrast to our hypothesis, UFC in the upper physiological range was associated with a favourable cardiovascular risk profile, bone measures and QoL.
authors.affiliation: Institute of Medicine at Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: oskar.ragnarsson@medic.gu.se.
authors.forename: Oskar
authors.initials: O
authors.lastname: Ragnarsson
authors.affiliation: Institute of Medicine at Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Penelope
authors.initials: P
authors.lastname: Trimpou
authors.affiliation: Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Oleröd
authors.affiliation: Institute of Medicine at Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Landin-Wilhelmsen
mesh_terms: D000328:Adult; D000368:Aged; D015519:Bone Density / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology / Q000652:urine*; D004305:Dose-Response Relationship, Drug; D005260:Female; D050723:Fractures, Bone / Q000150:complications; D005938:Glucocorticoids / Q000494:pharmacology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications
chemical_list: D005938:Glucocorticoids; D006854:Hydrocortisone
keywords: Bone; Glucocorticoids; Metabolic syndrome; Quality of life; Urinary free cortisol