Cortisone levels measured in scalp hair may predict future CVD risk
Click Here to Manage Email Alerts
Key takeaways:
- Each point increase in hair cortisone level is associated with a higher likelihood for incident CVD.
- The association between cortisone and incident CVD was only significant for adults aged 57 years and younger.
Adults with higher cortisone levels as measured in their scalp hair may be more likely to develop future cardiovascular disease, according to a presenter at the European Congress on Obesity.
“Higher long-term levels of stress hormones, measured in scalp hair, are known to be robustly associated with obesity as well as with CVD on a cross-sectional level,” Eline van der Valk, MD, a PhD candidate and internist in training at the Obesity Center CGG at Erasmus University Medical Center in Rotterdam, the Netherlands, told Healio. “It was, however, not known what comes first, the obesity and CVD or the increased stress hormone levels. We now demonstrated that higher stress hormones are also linked with future CVD, such as heart attacks and strokes, even when taking into account the ‘classical’ risk factors, such as high blood pressure, type 2 diabetes and smoking. Interestingly, the effect size of stress hormones on cardiovascular risk was, in our cohort, actually comparable to these classical risk factors.”
Van der Valk and colleagues analyzed data from 6,341 hair samples collected in 2014 during the Lifelines prospective cohort study. The hair samples were used to measure cortisol and cortisone levels. Incident CVD was analyzed during a follow-up visit conducted from 2019 to 2021.
There were 3,855 adults with hair samples available who completed their follow-up visit, of whom 233 were diagnosed with incident CVD. After adjusting for age, sex, waist circumference, smoking, systolic BP and the presence of type 2 diabetes, each point increase in 10-log cortisone concentration was associated with an increased likelihood for incident CVD (adjusted OR = 2.15; 95% CI, 0.99-4.55; P = .049). The association was only significant for younger adults. Among 1,956 adults aged 57 years and younger, each point increase in hair cortisone level was associated with higher odds for incident CVD (aOR = 3.7; 95% CI, 1.27-10.3; P = .014). No association between hair cortisone level and incident CVD was observed among adults aged 58 years and older. There was also no association found between hair cortisol levels and the likelihood for incident CVD.
“We did not expect to see such a strong age dependency of the role of stress hormones,” van der Valk said. “In our data, we saw a clear age-dependent effect, showing that in younger individuals, stress hormones had greater impact than in older individuals.”
Van der Valk said more studies must be conducted in other cohorts before stress hormones can be used as a predictor for CVD in clinical practice. Additionally, she said researchers must analyze whether decreasing cortisone levels can reduce CVD risk in the general population.
“If this all proves to be beneficial, we can imagine that, in the future, a hair stress hormone measurement might become part of the standard of care in CV risk management,” van der Valk said.
Perspective
Back to Top
I know many endocrinologists who panic over a stimulated cortisol value of 17.5 μg/dL and subject these patients to a lifetime of hydrocortisone therapy for missing the “normal” value of 18 μg/dL — never mind that 14 μg/dL to 15 μg/dL is normal with modern cortisol assays and 5 μg/dL suffices for most stressful events. In contrast, many endocrinologists will dismiss a dexamethasone-suppressed cortisol of 2.5 μg/dL as normal in a patient with a 2.5 cm adrenal mass, a “smoking gun,” despite the substantial evidence that any degree of hypercortisolemia increases the risk for cardiovascular events and related cardiometabolic diseases over many years. Part of the paradox is due to the difficulty in quantitating ACTH-independent cortisol production and gauging how much this contributes to the overall physiology in any given patient.
Cortisol deposits in hair proportionate to circulating concentrations and segmental hair cortisol measurements provide a continuous cortisol history over weeks to months. The finding from van der Valk and colleagues that higher hair cortisol correlates with CV events is consistent with longitudinal studies of patients with adrenal adenomas; however, cortisol also rises with the stress of disease. So, is this a cause-and-effect relationship? Provocative and worthy of further study, but a difficult problem to conclusively disentangle.
Collapse
van der Valk E, et al. AD14.06. Presented at: European Congress on Obesity; May 17-20, 2023; Dublin.
Read more about
Click Here to Manage Email Alerts