Author + information
- Received April 24, 2013
- Accepted May 7, 2013
- Published online October 29, 2013.
- Antonio I. Lazzarino, MD, MSc∗∗ (, )
- Mark Hamer, PhD∗,
- David Gaze, PhD†,
- Paul Collinson, MD† and
- Andrew Steptoe, DSc∗
- ∗Department of Epidemiology and Public Health, University College London, London, United Kingdom
- †Chemical Pathology, Clinical Blood Sciences, St. George's Healthcare NHS Trust, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Antonio Lazzarino, University College of London, Department of Epidemiology and Public Health, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
Objectives The objective of this study was to examine the association between cortisol response to mental stress and high-sensitivity cardiac troponin T (hs-cTnT) in healthy older individuals without history of cardiovascular disease (CVD).
Background Mental stress is a recognized risk factor for CVD, although the mechanisms remain unclear. Cortisol, a key stress hormone, is associated with coronary atherosclerosis and may accentuate structural and functional cardiac disease.
Methods This cross-sectional study involved 508 disease-free men and women aged 53 to 76 years drawn from the Whitehall II epidemiological cohort. We evaluated salivary cortisol response to standardized mental stress tests (exposure) and hs-cTnT plasma concentration using a high-sensitivity assay (outcome). We measured coronary calcification using electron-beam dual-source computed tomography and Agatston scores.
Results After adjustment for demographic and clinical variables associated with CVD as well as for inflammatory factors, we found a robust association between cortisol response and detectable hs-cTnT (odds ratio [OR]: 3.98; 95% confidence interval [CI]: 1.60 to 9.92; p = 0.003). The association remained when we restricted the analysis to participants without coronary calcification (n = 222; OR: 4.77; 95% CI: 1.22 to 18.72; p = 0.025) or when we further adjusted for coronary calcification in participants with positive Agatston scores (n = 286; OR: 7.39; 95% CI: 2.22 to 26.24; p = 0.001).
Conclusions We found that heightened cortisol response to mental stress was associated with detectable plasma levels of cTnT using high-sensitivity assays in healthy participants, independently of coronary atherosclerosis. Further research is needed to understand the role of psychosocial stress in the pathophysiology of cardiac cell damage.
This research was supported by the British Heart Foundation and the Medical Research Council, United Kingdom. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 24, 2013.
- Accepted May 7, 2013.
- 2013 American College of Cardiology Foundation