Standard Modifiable Cardiovascular Risk Factors Mediate the Association Between Elevated Hair Cortisol Concentrations and Coronary Artery Disease

Andreas Stomby; Susanna Strömberg; Elvar Theodorsson; Åshild Olsen Faresjö; Mike Jones; Tomas Faresjö

doi:10.3389/fcvm.2021.765000

Standard Modifiable Cardiovascular Risk Factors Mediate the Association Between Elevated Hair Cortisol Concentrations and Coronary Artery Disease

Front Cardiovasc Med. 2022 Jan 25:8:765000. doi: 10.3389/fcvm.2021.765000. eCollection 2021.

Authors

Andreas Stomby^{1

2}, Susanna Strömberg¹, Elvar Theodorsson³, Åshild Olsen Faresjö⁴, Mike Jones⁵, Tomas Faresjö¹

Affiliations

¹ Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
² Råslätts vårdcentral, Region Jönköping County, Jönköping, Sweden.
³ Department of Biomedical and Clinical Science, Clinical Chemistry, Linköping University, Linköping, Sweden.
⁴ Division of Society and Health/Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
⁵ Faculty of Medicine Health and Human Sciences, School of Psychological Sciences, Macquarie University, North Ryde, NSW, Australia.

Abstract

Background: Increased cortisol exposure is a risk factor for coronary artery disease (CAD). It is not clear to what degree this risk is independent from the standard modifiable risk factors (SMuRFs) dyslipidemia, hypertension, and diabetes.

Aim: To use path analysis to test the direct and indirect association, mediated by SMuRFs, between long-term cortisol levels measured in hair cortisol concentration (HCC) and CAD.

Methods: Hair was sampled from patients admitted with acute myocardial infarction (n = 203) and a population-based sample without a diagnosis or symptoms of CAD (n = 3,134). The HCC was analyzed using radioimmunoassay and all the participants reported whether they were diagnosed with or treated for diabetes, hypertension, and hyperlipidemia. Path analysis was used to test to what degree the association between logarithmized (ln) HCC and CAD was direct or indirect, mediated by SMuRFs.

Results: Participants with CAD had elevated HCC compared to those without elevated HCC [median interquartile range (IQR): 75.2 (167.1) vs. 23.6 (35.0) pg/mg, p < 0.0001]. Higher HCC was associated with diabetes, hypertension, and hyperlipidemia, which, in turn, were associated with CAD. In path models, 80% of the association between ln(HCC) and CAD were mediated by SMuRFs, while the direct path between ln(HCC) and CAD was not statistically significant.

Conclusion: The SMuRFs diabetes, hyperlipidemia, and hypertension mediate the association between ln(HCC) and CAD. Some association between ln(HCC) and CAD did not operate via the SMuRFs considered and might have a pathway through atherosclerosis or inflammation.

Keywords: biological stress; cardiovascular risk factors; coronary artery disease; cortisol; path analysis.