Flynn Spencer, Srikanthan Preethi, Ravellette Keeley, Inoue Kosuke, Watson Karol, Horwich Tamara
David Geffen School of Medicine at UCLA, United States of America.
UCLA Division of Endocrinology, United States of America.
Am Heart J Plus. 2023 Dec;36. doi: 10.1016/j.ahjo.2023.100344. Epub 2023 Nov 4.
Research suggests that women experience greater cardiovascular ischemic effects from stress than men. Visceral adiposity is an endocrine tissue that differs by sex and interacts with stress hormones. We hypothesized that urinary cortisol would be associated with increased cardiovascular events and change in coronary artery calcium score (CAC) in women, and these relationships would vary by central obesity. In the Multi-Ethnic Study of Atherosclerosis Stress Ancillary study, cortisol was quantified by 12-h overnight urine collection. Central obesity was estimated by waist-hip ratio (WHR). Multivariable Cox models estimated the relationship between cortisol and cardiovascular events and assessed for moderation by WHR. The relationship between cortisol and change in CAC Agatston score was assessed by Tobit regression models. 918 patients were analyzed with median follow up of 11 years. There was no association between urinary cortisol and cardiovascular events in the cohort. However, in individuals with below median WHR, higher urinary cortisol levels (upper tertile) were associated with higher cardiovascular event rates in the full cohort, women, and men, but not in groups with above median WHR. There was significant moderation by WHR in women, but not men, whereby the association between elevated cortisol and increased cardiovascular events diminished as WHR increased. Urinary cortisol was associated with increased change in CAC in women ( = 0.003) but not men, without moderation by WHR. Our study highlights associations between cortisol and subclinical atherosclerosis in women, and moderation of the relationship between cortisol and cardiovascular events by central obesity in both genders.
研究表明，与男性相比，女性因压力而经历的心血管缺血影响更大。内脏脂肪是一种内分泌组织，存在性别差异并与应激激素相互作用。我们假设，尿皮质醇与女性心血管事件增加及冠状动脉钙化评分（CAC）变化相关，且这些关系会因中心性肥胖而有所不同。在动脉粥样硬化应激辅助多民族研究中，通过12小时夜间尿液收集对皮质醇进行定量。通过腰臀比（WHR）评估中心性肥胖。多变量Cox模型估计皮质醇与心血管事件之间的关系，并评估WHR的调节作用。通过Tobit回归模型评估皮质醇与CAC阿加斯顿评分变化之间的关系。对918名患者进行了分析，中位随访时间为11年。该队列中尿皮质醇与心血管事件之间无关联。然而，在WHR低于中位数的个体中，较高的尿皮质醇水平（上三分位数）与整个队列、女性和男性的心血管事件发生率较高相关，但在WHR高于中位数的组中则不然。女性中WHR有显著的调节作用，而男性则没有，即随着WHR的增加，皮质醇升高与心血管事件增加之间的关联减弱。尿皮质醇与女性CAC变化增加相关（ = 0.003），但与男性无关，且不受WHR的调节。我们的研究强调了皮质醇与女性亚临床动脉粥样硬化之间的关联，以及中心性肥胖对两性皮质醇与心血管事件之间关系的调节作用。
