Lower diurnal HPA-axis activity in male hypertensive and coronary heart disease patients predicts future CHD risk.

Details

Ressource 1Request a copy Under indefinite embargo.
UNIL restricted access
State: Public
Version: author
License: CC BY 4.0
Serval ID
serval:BIB_88B91AB2EE1A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Lower diurnal HPA-axis activity in male hypertensive and coronary heart disease patients predicts future CHD risk.
Journal
Frontiers in endocrinology
Author(s)
Degroote C., von Känel R., Thomas L., Zuccarella-Hackl C., Messerli-Bürgy N., Saner H., Wiest R., Wirtz P.H.
ISSN
1664-2392 (Print)
ISSN-L
1664-2392
Publication state
Published
Issued date
2023
Peer-reviewed
Oui
Volume
14
Pages
1080938
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
Coronary heart disease (CHD) and its major risk factor hypertension have both been associated with altered activity of the hypothalamus-pituitary-adrenal (HPA)-axis but the biological mechanisms underlying prospective associations with adverse disease outcomes are unclear. We investigated diurnal HPA-axis activity in CHD-patients, hypertensive (HT) and healthy normotensive men (NT) and tested for prospective associations with biological CHD risk factors.
Eighty-three male CHD-patients, 54 HT and 54 NT men repeatedly measured salivary cortisol over two consecutive days. Prospective CHD risk was assessed by changes between baseline and follow-up in the prothrombotic factors D-dimer and fibrinogen, the pro-inflammatory measures interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and acute phase protein C-reactive protein (CRP), as well as blood lipids in terms of total cholesterol (tChol)/high-density-lipoprotein cholesterol (HDL)-ratio. We aggregated coagulation and inflammatory measures to respective indices.
The groups differed in repeated daytime cortisol (dayCort) secretion (p=.005,η <sup>2</sup> <sub>p</sub> =.03,f=0.18) and cortisol awakening response (CAR) (p=.006,η <sup>2</sup> <sub>p</sub> =.03,f=0.18), with similarly lower overall dayCort and CAR in CHD-patients and HT, as compared to NT. The groups differed further in cortisol at awakening (p=.015,η <sup>2</sup> <sub>p</sub> =.04,f=0.20) with highest levels in HT (p´s≤.050), and in diurnal slope between waking and evening cortisol (p=.033,η <sup>2</sup> <sub>p</sub> =.04,f=0.20) with steepest slopes in HT (p´s≤.039), although in part not independent of confounders. Lower aggregated dayCort and CAR in terms of area-under-the-curve (AUC) independently predicted increases in future overall CHD risk (AUC <sub>dayCort</sub> : p=.021,η <sup>2</sup> <sub>p</sub> =.10,f=0.33;AUC <sub>CAR</sub> : p=.028,η <sup>2</sup> <sub>p</sub> =.09,f=0.31) 3.00 ± 0.06(SEM) years later, with risk prediction most pronounced in fibrinogen (AUC <sub>dayCort</sub> : p=.017,ΔR <sup>2</sup> = 0.12;AUC <sub>CAR</sub> : p=.082).
We found evidence for an HPA-axis hypoactivity in CHD and HT with lower diurnal HPA-axis activity predicting increases in cardiovascular risk as evidenced by increases in circulating levels of biomarkers of atherothrombotic risk. Down-regulation of basal HPA-axis activity may contribute to the pathogenesis of atherosclerosis and thrombosis in CHD via effects on coagulation.
Keywords
Humans, Male, Hydrocortisone/metabolism, Saliva/metabolism, Hypothalamo-Hypophyseal System/metabolism, Hypertension, Coronary Disease/etiology, Coronary Disease/metabolism, HPA-axis, coagulation, coronary heart disease, cortisol, hypertension
Pubmed
Open Access
Yes
Create date
06/04/2023 13:18
Last modification date
19/07/2023 6:55
Usage data