Cortisol and vital exhaustion in relation to significant coronary artery stenosis in middle-aged women with acute coronary syndrome.

Background: The role of chronic stress in coronary artery disease (CAD) is not well known. Conflicting results have been obtained with regard to the stress hormone cortisol and 'vital exhaustion', a psychological construct defining the effects of long-term stress. We investigated the relationship between chronic stress, assessed by serum cortisol and vital exhaustion, and coronary artery stenosis and the importance of chronic stress in relation to standard risk factors of CAD.
Methods and Results: Women, <or=65 years, consecutively admitted to coronary care units presenting with acute coronary syndrome, were examined after 3-6 months regarding morning serum cortisol, vital exhaustion, lifestyle, clinical variables, and coronary artery stenosis. Evaluated from coronary angiography in 238 patients, coronary stenosis was dichotomized to significant vs non-significant luminal narrowing (<50%). Women with coronary stenosis (>or=50%) had elevated cortisol levels compared to the others (p=0.009). A 25% increase of cortisol increased the probability of significant coronary stenosis by 41% (p=0.005). Compared to standard risk variables of CAD, only high-density lipoprotein cholesterol (HDL-C) was a more important predictor. Each 25% decrease of HDL-C increased the probability of significant coronary stenosis by 65% (p=0.0021). Vital exhaustion was not related to coronary stenosis (p=0.47). However, it appeared to have an additive effect as women with both a cortisol level and vital exhaustion score above the sample median, had a near three-fold risk of having CAD, OR=2.85 (95% CI 1.31-6.18), compared to those who did not have this combination. The results remained after adjusting for age, glucose, and use of calcium channel- and beta-blockers.
Conclusion: Cortisol, but not vital exhaustion, was independently related to coronary stenosis in women with acute coronary syndrome. The influence of cortisol was important compared to standard risk factors of CAD.