Serum cortisol predicts increased cardiovascular mortality in patients with acute coronary syndrome: the Ludwigshafen Risk and Cardiovascular Health (LURIC) Study
Andreas Tomaschitz1, Stefan Pilz1, Eberhard Ritz2, Tanja Grammer3, Christiane Drechsler4, Bernhard Boehm5 & Winfried Maerz3,6
Over the past several years, growing evidence suggested that serum cortisol is associated with increased cardiovascular (CVD) mortality in patients with chronic heart failure. The prognostic significance of serum cortisol concentration (SCC) in patients with acute coronary syndrome (ACS) however is unknown.
In the prospective Ludwigshafen Risk and Cardiovascular Health (LURIC) study 3316 patients (median age: 63.5 (56.370.6) years; 30.2% women) were referred for coronary angiography. Of these, 1036 participants revealed an acute coronary syndrome and were followed-up for almost 8 years. Mean SCC (22.5±10.5 vs 22.2±8.3 μg/dl; P=0.386; (normal range: 9.423.9 μg/dl)) as well as norepinephrine levels (P=0.378), frequency of severe heart failure (NYHA III/IV; P=0.156)) and left ventricular dysfunction (P=0.062) did not differ significantly between patients with and without ACS, respectively. During a median follow-up of 7.75 years 146 (14.1%) patients with ACS at baseline died due to cardiovascular causes. Multivariate adjusted Cox proportional hazard analysis was performed to assess the risk for death from CVD as a function of SCC quartiles. The hazard ratio for highest versus lowest quartile of SCC was 1.89 (1.123.19; P=0.018). Addition of plasma aldosterone and norepinephrine levels to the fully adjusted model only marginally impacted this association (1.85 (1.043.27; P=0.035)).
To the best of our knowledge, this is the first prospective study that found a specific and independent association between SCC and incident fatal CVD events in patients with ACS.