CONTEXT: Evidence for the association of cortisol with mortality or disease events is mixed, possibly due to a failure to consider diurnal cortisol patterns. OBJECTIVE: Our objective was to examine the association of diurnal cortisol patterns throughout the day with cardiovascular and noncardiovascular mortality in a community-dwelling population. DESIGN: This was a prospective cohort study among 4047 civil servants, the Whitehall II study, United Kingdom. We measured diurnal cortisol patterns in 2002-2004 from six saliva samples obtained over the course of a normal weekday: at waking, +30 min, +2.5 h, +8 h, +12 h, and bedtime. Participants were subsequently followed for all-cause and cause-specific mortality until January 2010. PARTICIPANTS: Participants included 4047 men and women aged 61 yr on average at baseline. OUTCOMES: We assessed all-cause, cardiovascular, and noncardiovascular death. RESULTS: There were 139 deaths, 32 of which were deaths due to cardiovascular disease, during a mean follow-up period of 6.1 yr. Flatter slopes in cortisol decline across the day were associated with increased risk of all-cause mortality (hazard ratio for 1 sd reduction in slope steepness 1.30; 95% confidence interval (CI) = 1.09-1.55). This excess mortality risk was mainly driven by an increased risk of cardiovascular deaths (hazard ratio = 1.87; 95% confidence interval = 1.32-2.64). The association with cardiovascular deaths was independent of a wide range of covariates measured at the time of cortisol assessment. There was no association between morning cortisol, the cortisol awakening response, and mortality outcomes. CONCLUSIONS: These findings demonstrate, for the first time, the relationship between a flatter slope in cortisol levels across the day and an increased risk of cardiovascular disease mortality in a nonclinical population.
CONTEXT: Evidence for the association of cortisol with mortality or disease events is mixed, possibly due to a failure to consider diurnal cortisol patterns. OBJECTIVE: Our objective was to examine the association of diurnal cortisol patterns throughout the day with cardiovascular and noncardiovascular mortality in a community-dwelling population. DESIGN: This was a prospective cohort study among 4047 civil servants, the Whitehall II study, United Kingdom. We measured diurnal cortisol patterns in 2002-2004 from six saliva samples obtained over the course of a normal weekday: at waking, +30 min, +2.5 h, +8 h, +12 h, and bedtime. Participants were subsequently followed for all-cause and cause-specific mortality until January 2010. PARTICIPANTS: Participants included 4047 men and women aged 61 yr on average at baseline. OUTCOMES: We assessed all-cause, cardiovascular, and noncardiovascular death. RESULTS: There were 139 deaths, 32 of which were deaths due to cardiovascular disease, during a mean follow-up period of 6.1 yr. Flatter slopes in cortisol decline across the day were associated with increased risk of all-cause mortality (hazard ratio for 1 sd reduction in slope steepness 1.30; 95% confidence interval (CI) = 1.09-1.55). This excess mortality risk was mainly driven by an increased risk of cardiovascular deaths (hazard ratio = 1.87; 95% confidence interval = 1.32-2.64). The association with cardiovascular deaths was independent of a wide range of covariates measured at the time of cortisol assessment. There was no association between morning cortisol, the cortisol awakening response, and mortality outcomes. CONCLUSIONS: These findings demonstrate, for the first time, the relationship between a flatter slope in cortisol levels across the day and an increased risk of cardiovascular disease mortality in a nonclinical population.
Authors: Janice E Williams; Thomas H Mosley; Willem J Kop; David J Couper; Verna L Welch; Wayne D Rosamond Journal: Am J Cardiol Date: 2010-06-15 Impact factor: 2.778
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Authors: Richard S Lee; Pamela B Mahon; Peter P Zandi; Mary E McCaul; Xiaoju Yang; Utsav Bali; Gary S Wand Journal: Psychoneuroendocrinology Date: 2018-07-04 Impact factor: 4.905
Authors: Melissa A Rosenkranz; Richard J Davidson; Donal G Maccoon; John F Sheridan; Ned H Kalin; Antoine Lutz Journal: Brain Behav Immun Date: 2012-10-22 Impact factor: 7.217
Authors: Mark L Laudenslager; Jacqueline Calderone; Sam Philips; Crystal Natvig; Nichole E Carlson Journal: Psychoneuroendocrinology Date: 2013-03-13 Impact factor: 4.905