Reynolds R M, Ilyas B, Price J F, Fowkes F G R, Newby D E, Webb D J, Walker B R
Centre for Cardiovascular Sciences, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, Scotland, UK.
QJM. 2009 Jul;102(7):469-75. doi: 10.1093/qjmed/hcp057. Epub 2009 May 20.
Although the prevalence of cardiovascular disease is declining, the obesity epidemic with associated metabolic syndrome may reverse this trend. Hypothalamic-pituitary-adrenal (HPA) axis activation may underlie the metabolic syndrome, but whether circulating cortisol levels predict vascular disease is less clear. A recent study reported a positive correlation between cortisol levels measured prior to coronary angiography and disease severity, but others have not demonstrated such a relationship. This may be due to different sampling conditions, reflecting basal cortisol levels, vs. responsiveness of HPA axis activity, which may have diverse influences on the pathogenesis of atherosclerosis.
To determine whether basal circulating cortisol levels predict coronary artery (CAD) or peripheral vascular disease.
Basal plasma cortisol levels were measured in 278 subjects with suspected CAD, who had undergone elective coronary angiography and in 76 cases and 85 controls with and without peripheral vascular disease, respectively.
After adjustment for potential confounding factors, circulating cortisol levels tended to be lower in those with confirmed coronary vessel disease at angiography (P = 0.10), and in those requiring intervention following angiography (P = 0.07). Lower cortisol levels also predicted those with more symptoms of angina (P = 0.01). Cortisol levels were no different in those with or without peripheral vascular disease.
A single measurement of circulating cortisol is a poor predictor of vascular disease. More detailed characterization of the HPA axis is necessary to determine the role of circulating endogenous glucocorticoids and their responsiveness to stress in atherosclerosis.
尽管心血管疾病的患病率正在下降，但肥胖流行及其相关的代谢综合征可能会扭转这一趋势。下丘脑 - 垂体 - 肾上腺（HPA）轴激活可能是代谢综合征的基础，但循环皮质醇水平是否能预测血管疾病尚不清楚。最近一项研究报告称，冠状动脉造影术前测量的皮质醇水平与疾病严重程度呈正相关，但其他研究并未证实这种关系。这可能是由于不同的采样条件，反映基础皮质醇水平与HPA轴活动的反应性，这可能对动脉粥样硬化的发病机制有不同影响。
确定基础循环皮质醇水平是否能预测冠状动脉疾病（CAD）或外周血管疾病。
分别在278例疑似CAD且接受了选择性冠状动脉造影的受试者、76例有外周血管疾病的病例和85例无外周血管疾病的对照中测量基础血浆皮质醇水平。
在调整潜在混杂因素后，血管造影确诊为冠状动脉疾病的患者（P = 0.10）以及血管造影后需要干预的患者（P = 0.07），其循环皮质醇水平往往较低。较低的皮质醇水平也预示着心绞痛症状更严重的患者（P = 0.01）。有或无外周血管疾病的患者皮质醇水平无差异。
单次测量循环皮质醇对血管疾病的预测价值不大。需要更详细地描述HPA轴，以确定循环内源性糖皮质激素及其对应激的反应性在动脉粥样硬化中的作用。
