von Känel Roland, Mausbach Brent T, Kudielka Brigitte M, Orth-Gomér Kristina
Department of General Internal Medicine, University Hospital, Berne 3010, Switzerland.
J Thromb Thrombolysis. 2008 Apr;25(2):165-72. doi: 10.1007/s11239-007-0035-7. Epub 2007 Jun 12.
Increased circulating cortisol levels have been associated with severity of atherosclerosis. Low-grade systemic thrombogenicity plays a major role in the initiation and progression of coronary disease. We hypothesized a direct relationship between cortisol and hemostasis factors related to a prothrombotic state in coronary artery disease.
We measured morning serum cortisol and activated clotting factor VII, fibrinogen, von Willebrand factor antigen, and plasminogen activator inhibitor-1 activity in 285 women (56 +/- 7 years) between 3 and 6 months after an acute coronary event. To test whether the relationship between cortisol and hemostasis factors would be independent, statistical adjustment was made for demographic, biomedical, life style, and psychosocial variables.
Higher serum cortisol levels predicted higher fibrinogen (beta = .17, P = .001) and higher von Willebrand factor (beta = .16, P = .008), all independently of covariates, including C-reactive protein, which was also an independent predictor of fibrinogen (beta = .20, P = .001) and von Willebrand factor (beta = .16, P = .004). Higher levels of vital exhaustion were associated with higher levels of activated clotting factor VII independently of covariates and depression (beta = .18, P = .045). Cortisol showed crude correlations with vital exhaustion (r = .14, P = .022) and with depression (r = .13, P = .043) but did not mediate the relationship between psychosocial variables and hemostatic factors.
Morning serum cortisol showed a modest but independent association with prothrombotic activity in women with coronary artery disease suggesting that increased cortisol levels might contribute to atherosclerosis via eliciting a hypercoagulable state.
循环皮质醇水平升高与动脉粥样硬化的严重程度相关。低度全身性血栓形成倾向在冠心病的发生和发展中起主要作用。我们推测皮质醇与冠心病中与血栓前状态相关的止血因子之间存在直接关系。
我们在285名（年龄56±7岁）急性冠脉事件发生后3至6个月的女性中测量了早晨血清皮质醇、活化凝血因子VII、纤维蛋白原、血管性血友病因子抗原和纤溶酶原激活物抑制剂-1活性。为了检验皮质醇与止血因子之间的关系是否独立，我们对人口统计学、生物医学、生活方式和心理社会变量进行了统计调整。
较高的血清皮质醇水平预示着较高的纤维蛋白原水平（β = 0.17，P = 0.001）和较高的血管性血友病因子水平（β = 0.16，P = 0.008），所有这些均独立于协变量，包括C反应蛋白，C反应蛋白也是纤维蛋白原（β = 0.20，P = 0.001）和血管性血友病因子（β = 0.16，P = 0.004）的独立预测因子。较高的活力耗竭水平与较高的活化凝血因子VII水平独立于协变量和抑郁相关（β = 0.18，P = 0.045）。皮质醇与活力耗竭（r = 0.14，P = 0.022）和抑郁（r = 0.1
