(23-06-10) Elevated fasting plasma cortisol is associated with ischemic heart disease and its risk factors in people with type 2 diabetes:

the Edinburgh type 2 diabetes study.


Reynolds RM, Labad J, Strachan MW, Braun A, Fowkes FG, Lee AJ, Frier BM, Seckl
JR, Walker BR, Price JF; Edinburgh Type 2 Diabetes Study (ET2DS) Investigators.

Collaborators (3)
Endocrinology Unit, Centre for Cardiovascular Science, Queen's Medical
Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United
Kingdom. [email protected]
Abstract
CONTEXT: Increased activity of the hypothalamic-pituitary-adrenal (HPA) axis
may underlie the metabolic syndrome, but whether circulating cortisol levels
predict cardiovascular end points is less clear. People with type 2 diabetes
are at increased cardiovascular disease risk and thus are suitable to study
associations of plasma cortisol with cardiovascular risk. OBJECTIVE: We aimed
to assess whether altered HPA axis activity was associated with features of the
metabolic syndrome and ischemic heart disease in people with type 2 diabetes.
DESIGN AND SETTING: We conducted a cross-sectional cohort study in the general
community, including 919 men and women aged 67.9 (4.2) yr with type 2 diabetes
(the Edinburgh Type 2 Diabetes Study). INTERVENTION: We measured fasting
morning plasma cortisol. MAIN OUTCOME MEASUREMENT: Associations between
cortisol levels, features of the metabolic syndrome, obesity, and ischemic
heart disease were determined. RESULTS: Elevated plasma cortisol levels were
associated with raised fasting glucose and total cholesterol levels (P <
0.001). These findings remained significant after adjustment for potential
confounding factors (P < 0.001). Elevated cortisol levels were associated with
prevalent ischemic heart disease (>800 vs. <600 nmol/liter; odds ratio, 1.58; P
= 0.02). This association remained significant after adjustment for duration
and control of diabetes and other cardiovascular risk factors (P = 0.03).
CONCLUSIONS: The previously described associations between HPA axis activation
and features of the metabolic syndrome are present among people with type 2
diabetes. Elevated plasma cortisol is also associated with a greater prevalence
of ischemic heart disease, independent of conventional risk factors.
Understanding the role of cortisol in the pathogenesis of ischemic heart
disease merits further exploration.

Source : J Clin Endocrinol Metab. 2010 Apr;95(4):1602-8. Epub 2010 Feb 3.

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