1 Department of Medicine, University of Calgary, Canada.
2 Department of Community Health Sciences, University of Calgary, Canada.
Eur J Prev Cardiol. 2018 Jan;25(1):65-72. doi: 10.1177/2047487317734323. Epub 2017 Oct 3.
Background Glucocorticoid excess has been linked with cardiovascular disease. Little is known about the long-term cortisol response in patients after acute coronary syndrome. Design The objective of this study was to describe the distribution of salivary cortisol in the post-acute phase of acute coronary syndrome and to describe the association of late-night salivary cortisol with cardiovascular risk factors. Methods We used late-night salivary cortisol measurements post-discharge to estimate hypothalamic-pituitary-adrenal axis activity in 309 patients aged 18-55 years enrolled in the GENESIS-PRAXY study from January 2009-April 2013. We evaluated hypothalamic-pituitary-adrenal axis activity and its association with hypertension, dyslipidemia, diabetes, smoking, family history, prior acute coronary syndrome, psychiatric diseases, acute coronary syndrome severity, as well as mortality and rate of rehospitalization at 12 months. Results Persistently elevated late-night salivary cortisol>2.92 nmol/l was seen in 99 (32.0%) patients: within the range of what may be seen in Cushing's disease. Elevated late-night salivary cortisol was associated with previous acute coronary syndrome (13.3% vs 24.2%, p = 0.02), peripheral vascular disease (3.8% vs 13.1%, p = 0.002), and smoking (32.9% vs 46.5% p = 0.02). Elevated late-night salivary cortisol was associated with higher hemoglobin A1c values (5.6 ± 3.0 vs 6.1 ± 2.9, p = 0.008) and lower high density lipoprotein values (0.94 ± 0.53 vs 0.86 ± 0.50, p = 0.01). There were no differences in psychiatric symptom scores, acute coronary syndrome severity or mortality, and rate of rehospitalization at 12 months. Conclusions Many patients post-acute coronary syndrome have prolonged, marked activation of the hypothalamic-pituitary-adrenal axis. Late-night salivary cortisol co-associates with several cardiovascular risk factors. Further studies are needed to confirm the exact role of hypothalamic-pituitary-adrenal axis activity in the pathophysiology of cardiovascular disease.
糖皮质激素过多与心血管疾病有关。人们对急性冠状动脉综合征后患者的长期皮质醇反应知之甚少。
本研究的目的是描述急性冠状动脉综合征后急性期唾液皮质醇的分布，并描述夜间唾液皮质醇与心血管危险因素的关系。
我们使用出院后的夜间唾液皮质醇测量来估计 309 名年龄在 18-55 岁的 GENESIS-PRAXY 研究患者的下丘脑-垂体-肾上腺轴活性，该研究于 2009 年 1 月至 2013 年 4 月进行。我们评估了下丘脑-垂体-肾上腺轴活性及其与高血压、血脂异常、糖尿病、吸烟、家族史、既往急性冠状动脉综合征、精神疾病、急性冠状动脉综合征严重程度以及 12 个月时的死亡率和再住院率的关系。
99 名（32.0%）患者的夜间唾液皮质醇持续升高>2.92 nmol/l：处于库欣病可能出现的范围内。夜间唾液皮质醇升高与既往急性冠状动脉综合征（13.3%比 24.2%，p=0.02）、外周血管疾病（3.8%比 13.1%，p=0.002）和吸烟（32.9%比 46.5%，p=0.02）有关。夜间唾液皮质醇升高与更高的血红蛋白 A1c 值（5.6±3.0 比 6.1±2.9，p=0.008）和更低的高密度脂蛋白值（0.94±0.53 比 0.86±0.50，p=0.01）有关。在精神症状评分、急性冠状动脉综合征严重程度或死亡率以及 12 个月时的再住院率方面无差异。
许多急性冠状动脉综合征后患者的下丘脑-垂体-肾上腺轴存在长期、显著的激活。夜间唾液皮质醇与多种心血管危险因素共同发生。需要进一步的研究来确认下丘脑-垂体-肾上腺轴活性在心血管疾病病理生理学中的确切作用。
