MsFLASH analysis of diurnal salivary cortisol and palpitations in peri- and postmenopausal women.

Objective: To evaluate the relationship between diurnal salivary cortisol patterns and distress from heart palpitations in midlife women.
Methods: We analyzed baseline data from 293 women who were eligible for a 3 × 2 factorial trial of exercise or yoga versus routine activity, and omega-3 fish oil versus placebo for vasomotor symptoms. Women self-collected salivary cortisol using swabs at four time points over 2 consecutive days and reported distress from heart racing or pounding during the past 2 weeks using a single item. Sample description and covariate data included demographics, clinical data, vasomotor symptom frequency from daily diaries, medication use, and validated questionnaires on depression, stress, and insomnia (Patient Health Questionnaire-8, Perceived Stress Scale, and Insomnia Severity index). Data were analyzed using descriptive statistics, chi-square and t tests, and repeated measure linear regression models.
Results: Participants were on average 54.6 (SD = 3.6) years old, most were White (67%) postmenopausal (84%), and 26% reported distress related to palpitations. In adjusted models, the morning (wake plus 30-min) geometric mean daily salivary cortisol concentrations were significantly more blunted in those with distress from palpitations compared with those without distress (P ≤ 0.03). When all covariates were controlled, distress from palpitations was the sole significant predictor of wake plus 30-minute cortisol (-0.25 [-0.45 to -0.04], P = 0.02).
Conclusions: Palpitations among midlife women may be associated with blunted morning cortisol, and this relationship is not explained by demographics, clinical variables, vasomotor symptoms, medications, depression, stress, or insomnia.
Competing Interests: Financial disclosures/conflicts of interest: J.S.C. reports personal fees from Kappa Santé and the University of Wisconsin Milwaukee. R.C.T. reports consulting fees from Astellas Pharma Inc, Pfizer, Proctor & Gamble, and Virtue Health. S.D.R. receives grant support from Bayer, AG, and receives royalties from UpToDate. J.E.T.'s institution receives funding from Indiana Clinical & Translational Sciences Institute, National Heart, Lung, and Blood Institute, Agency for Healthcare Research & Quality, and American Heart Association. J.E.T. receives a stipend for services as Scientific Editor of Pharmacotherapy (journal). D.V.A. receives honorarium for work for NIH/NCI for advisory board membership Palliative and Supportive Care PDQ. J.C.L., Y.S., C.X.C., R.K., and K.A.G. have nothing to disclose.
(Copyright © 2021 by The North American Menopause Society.)