Stress is associated with an increased risk of cardiovascular disease – independent of common risk factors such as smoking or obesity. It is suspected that this could be related to an altered release of cortisol, which can be observed in people who experience stress. Researchers from the Central Institute of Mental Health in Mannheim, the Institute of Epidemiology at Helmholtz Munich, the Department of Psychosomatic Medicine and Psychotherapy of the Klinikum Rechts der Isar and the German Center for Cardiovascular Research now report that people with such an altered release of cortisol have an increased risk of dying from cardiovascular disease years later.

Characteric cortisol secretion pattern

The researchers analyzed data from 1,090 participants in the KORA study, which has been studying the health of Augsburg-area citizens for more than 30 years. KORA is a German acronym for cooperative health research in the Augsburg region. The study participants collected four saliva samples over the course of a day. The researchers used these samples to determine a pattern for the secretion of the stress hormone cortisol throughout the day. In the following years, the researchers regularly recorded whether the participants suffered a heart attack, stroke or died.
In healthy people, the release of cortisol shows a characteristic pattern over the course of the day. Cortisol levels initially rise sharply after waking, reach a maximum after about 30 minutes, and then fall steadily until the evening. Studies in the past have shown that this rhythmic pattern is less pronounced in people experiencing chronic stress.

Altered cortisol secretion can have severe consequences

The present study showed that participants with a healthy cortisol secretion pattern, i.e. a pronounced increase in the morning and steady decrease throughout the day, had a lower risk of suffering a stroke or dying from cardiovascular disease. In contrast, participants with less pronounced changes in cortisol secretion throughout the day had a higher risk of dying from cardiovascular disease. Participants whose cortisol levels were higher in the evening also had an increased risk.
"Cortisol is often measured in stress research, while long-term consequences are only rarely measured," says Sebastian Karl, a medical doctor at the Department of Psychiatry and Psychotherapy of the Central Institute of Mental Health and the study's lead author. "That's why it's important to see that altered cortisol secretion can have measurable and serious long-term consequences." When measuring cortisol, the change in cortisol release over the course of the day seems more important than the total amount of cortisol released.

Publikation: Sebastian Karl, Hamimatunnisa Johar, Karl-Heinz Ladwig, Annette Peters, Florian Lederbogen: Dysregulated diurnal cortisol patterns are associated with cardiovascular mortality: Findings from the KORA-F3 study, Psychoneuroendocrinology. 2022 Mar 30;141:105753. DOI: 10.1016/j.psyneuen.2022.105753.