Pilz Stefan, Theiler-Schwetz Verena, Trummer Christian, Keppel Martin H, Grübler Martin R, Verheyen Nicolas, Odler Balazs, Meinitzer Andreas, Voelkl Jakob, März Winfried
Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria.
University Institute for Medical and Chemical Laboratory Diagnostics, Paracelsus Medical University, 5020 Salzburg, Austria.
J Endocr Soc. 2021 Feb 10;5(5):bvab017. doi: 10.1210/jendso/bvab017. eCollection 2021 May 1.
Serum cortisol may be associated with cardiovascular risk factors and mortality in patients undergoing coronary angiography, but previous data on this topic are limited and controversial.
We evaluated whether morning serum cortisol is associated with cardiovascular risk factors, lymphocyte subtypes, and mortality.
This is a prospective cohort study performed at a tertiary care centre in south-west Germany between 1997 and 2000. We included 3052 study participants who underwent coronary angiography. The primary outcome measures were cardiovascular risk factors, lymphocyte subtypes, and all-cause and cardiovascular mortality.
Serum cortisol was associated with an adverse cardiovascular risk profile, but there was no significant association with coronary artery disease or acute coronary syndrome. In a subsample of 2107 participants, serum cortisol was positively associated with certain lymphocyte subsets, including CD16+CD56+ (natural killer) cells ( < 0.001). Comparing the fourth versus the first serum cortisol quartile, the crude Cox proportional hazard ratios (with 95% CIs) were 1.22 (1.00-1.47) for all-cause and 1.32 (1.04-1.67) for cardiovascular mortality, respectively. After adjustments for various cardiovascular risk factors, these associations were attenuated to 0.93 (0.76-1.14) for all-cause, and 0.97 (0.76-1.25) for cardiovascular mortality, respectively.
Despite significant associations with classic cardiovascular risk factors and natural killer cells, serum cortisol was not a significant and independent predictor of mortality in patients referred to coronary angiography. These findings might reflect that adverse cardiovascular effects of cortisol could be counterbalanced by some cardiovascular protective actions.
血清皮质醇可能与接受冠状动脉造影的患者的心血管危险因素及死亡率相关，但此前关于该主题的数据有限且存在争议。
我们评估了清晨血清皮质醇是否与心血管危险因素、淋巴细胞亚群及死亡率相关。
这是一项于1997年至2000年在德国西南部一家三级医疗中心进行的前瞻性队列研究。我们纳入了3052名接受冠状动脉造影的研究参与者。主要结局指标为心血管危险因素、淋巴细胞亚群以及全因死亡率和心血管死亡率。
血清皮质醇与不良心血管风险谱相关，但与冠状动脉疾病或急性冠状动脉综合征无显著关联。在2107名参与者的亚样本中，血清皮质醇与某些淋巴细胞亚群呈正相关，包括CD16 + CD56 +（自然杀伤）细胞（<0.001）。比较血清皮质醇四分位数的第四组与第一组，全因死亡率的粗Cox比例风险比（及95%置信区间）为1.22（1.00 - 1.47），心血管死亡率为1.32（1.04 - 1.67）。在对各种心血管危险因素进行调整后，这些关联分别减弱至全因死亡率为0.93（0.76 - 1.14），心血管死亡率为0.97（0.76 - 1.25）。
尽管血清皮质醇与经典心血管危险因素及自然杀伤细胞存在显著关联，但在接受冠状动脉造影的患者中，它并非死亡率的显著且独立预测因素。这些发现可能反映出皮质醇的不良心血管作用可能被一些心血管保护作用所抵消。
