title: The relationship between preoperative serum cortisol level and the stability of plaque in carotid artery stenosis patients undergoing carotid endarterectomy.
abstract: BACKGROUND
  Stability of plaque has been implicated as risk factor for stroke. Serum cortisol regulates lipoprotein metabolism and immune response, contributing to plaque stability in atherosclerosis. However, the relationship between serum cortisol and stability of carotid plaque has not been well characterized. We conducted a serology analysis to identify the relationship between serum cortisol and carotid plaque stability.
  
  
  METHODS
  Between May 2013 to October 2015, 73 patients with carotid stenosis patients undergoing carotid endarterectomy (CEA) were enrolled in our study. Serum cortisol was analyzed at 8:00 AM in the morning before surgery via liquid chromatography tandem mass spectrometry. According to the classification made by the American Heart Association, hematoxylin-and-eosin staining was performed to divide these patients into either a stable or unstable group, according to the morphology of fibrous cap, lipid core and intima layer. A curve fitting method was used to identify the relationship between preoperative serum cortisol and stability of carotid plaque. Univariate and multivariate logistic regression analysis were used to identify carotid plaque stability-associated serum cortisol.
  
  
  RESULTS
  Curve fitting's result represents a U-shape characteristic. A total of 314.92 and 395.23 nmol/L were considered as the cut point for preoperative serum cortisol when trisected the patients. When adjusted for degree of stenosis, hyperlipemia, smoking and low-density lipoprotein (LDL), univariate and multivariate logistic regression analysis' results demonstrated that preoperative serum cortisol can significantly affect carotid plaque stability. The odds ratio values in multivariate logistic regression analysis for C reactive protein (CRP), white blood cell (WBC), interleukin-6 (IL-6) and preoperative serum cortisol level were 7.67 and 20.86 respectively.
  
  
  CONCLUSIONS
  Preoperative serum cortisol was associated with stability of carotid plaque in patients undergoing CEA. Low or high levels of preoperative serum cortisol might be an adverse factor for carotid plaque stability.
authors: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors: Feng
authors: F
authors: Qin
authors: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors: Yudong
authors: Y
authors: Sun
authors: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors: Wenping
authors: W
authors: Hu
authors: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors: Xiaolong
authors: X
authors: Wei
authors: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors: Zhenjiang
authors: Z
authors: Li
authors: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors: Jian
authors: J
authors: Zhou
authors: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors: Zhiqing
authors: Z
authors: Zhao
authors: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors: Zaiping
authors: Z
authors: Jing
keywords: Cortisol; carotid arteries; carotid endarterectomy (CEA); plaque; stability