High blood cortisol levels significantly increases death rate in patients with acute coronary syndrome

Until now, the significance of cortisol levels in patients with acute coronary syndrome (ACS) has been unknown. Cortisol is a hormone produced by the adrenal gland. Amongst other actions, it modifies our reactions to stress and anxiety, regulates blood pressure and helps to keep blood sugar levels within normal ranges. Now a group of researchers headed by Dr Andreas Tomaschitz at the Medical University of Graz-Austria (Team: Stefan Pilz, Medical University of Graz, Austria and Tanja Grammer, Synlab Center of Laboratory Diagnostics, Germany) have used the information from a German heart study to show the link between serum cortisol levels and increased mortality in patients with ACS.

The LURIC (Ludwigshafen Risk and Cardiovascular Health; headed by the principal investigator Prof. Winfried März, Synlab Center of Laboratory Diagnostics, Germany) study is an ongoing trial designed to investigate the effects of genetic and other biological traits on the cardiovascular system. The study has enrolled over 3000 participants for coronary angiography at the Herzzentrum, Ludwigshafen, Germany.

For this work, 1036 patients with acute coronary syndrome were studied for an average period of 7.7 years. There were no significant differences in the serum cortisol levels between patients with and without acute coronary syndrome. However, the patients with ACS and high cortisol levels had a significantly elevated number of deaths when compared to the patients with ACS and the lowest cortisol levels. 758 total deaths were reported during the follow-up period. The ACS patients with the highest cortisol levels (i.e. the highest 25% serum cortisol) were significantly more likely to die from fatal cardiovascular events than those with the lowest cortisol levels (the lowest 25% serum cortisol). (The hazard ratio for highest versus lowest quartile of SCC was 1.89 (1.12-3.19; P=0.018)).

Lead researcher, Dr Andreas Tomaschitz, said:

"These findings show for the first time that serum cortisol levels are strongly linked to higher death rates in patients with acute coronary syndrome. They suggest that cortisol might play an important role in worsening cardiovascular damage. Until now cortisol has been thought of as a non-specific stress indicator, but given that there was no real difference between the acute coronary syndrome and non acute coronary syndrome groups, we may have to reconsider this. In the future we will need to understand the complex way in which cells to react to cortisol, and how this causes cardiovascular damage to people with acute coronary syndrome."