title: Diurnal Cortisol Rhythm Is Associated With Adverse Cardiac Events and Mortality in Coronary Artery Bypass Patients.
abstract: OBJECTIVE
  There is growing evidence that the hypothalamic-pituitary-adrenal axis plays a role in the progression of cardiovascular disease. We examined the relationship between diurnal cortisol rhythm and adverse events in patients undergoing coronary artery bypass graft (CABG) surgery. We hypothesized that a flatter presurgical diurnal cortisol slope would be associated with higher rates of adverse cardiac events and death in the years following the CABG procedure.
  
  
  METHODS
  Repeated measures of saliva were taken over the day from 250 CABG patients 1 month before surgery to assess diurnal cortisol slope and overall output (area under the curve). Long-term clinical outcomes were occurrence of a major adverse cardiac event (MACE) and death, and were collected up to 2.68 (SD = 0.40) years after surgery. Cox proportional hazard models were used to determine relationships between presurgical cortisol and clinical outcomes. EuroSCORE, chronic illness burden, and whether or not the patient had undergone cardiopulmonary bypass were included as covariates in the models.
  
  
  RESULTS
  Diurnal cortisol slope predicted the occurrence of MACE or death after surgery (hazard ratio = 0.73; 95% confidence interval = 0.56-0.96; P = .023). Patients with a steeper slope were at reduced risk of adverse outcomes. This association was driven by changes in both waking and evening cortisol levels.
  
  
  CONCLUSIONS
  These results provide evidence for a link between diurnal cortisol rhythm and recovery after CABG. Measuring diurnal cortisol slope before surgery may help to identify those patients at risk of adverse outcomes in the years after the procedure.
authors: Department of Epidemiology and Public Health (A.R., T.K., L.P., E.L., A.S.), University College London, London WC1E 6BT, United Kingdom; and Department of Cardiac Surgery (M.J.), St. George's Hospital, University of London, London SW17 0QT, United Kingdom.
authors: Amy
authors: A
authors: Ronaldson
authors: Department of Epidemiology and Public Health (A.R., T.K., L.P., E.L., A.S.), University College London, London WC1E 6BT, United Kingdom; and Department of Cardiac Surgery (M.J.), St. George's Hospital, University of London, London SW17 0QT, United Kingdom.
authors: Tara
authors: T
authors: Kidd
authors: Department of Epidemiology and Public Health (A.R., T.K., L.P., E.L., A.S.), University College London, London WC1E 6BT, United Kingdom; and Department of Cardiac Surgery (M.J.), St. George's Hospital, University of London, London SW17 0QT, United Kingdom.
authors: Lydia
authors: L
authors: Poole
authors: Department of Epidemiology and Public Health (A.R., T.K., L.P., E.L., A.S.), University College London, London WC1E 6BT, United Kingdom; and Department of Cardiac Surgery (M.J.), St. George's Hospital, University of London, London SW17 0QT, United Kingdom.
authors: Elizabeth
authors: E
authors: Leigh
authors: Department of Epidemiology and Public Health (A.R., T.K., L.P., E.L., A.S.), University College London, London WC1E 6BT, United Kingdom; and Department of Cardiac Surgery (M.J.), St. George's Hospital, University of London, London SW17 0QT, United Kingdom.
authors: Marjan
authors: M
authors: Jahangiri
authors: Department of Epidemiology and Public Health (A.R., T.K., L.P., E.L., A.S.), University College London, London WC1E 6BT, United Kingdom; and Department of Cardiac Surgery (M.J.), St. George's Hospital, University of London, London SW17 0QT, United Kingdom.
authors: Andrew
authors: A
authors: Steptoe
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000097:blood* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry
chemical_list: D006854:Hydrocortisone