The Association Between Cortisol Response to Mental Stress and High-Sensitivity Cardiac Troponin T Plasma Concentration in Healthy Adults

• Published in: Journal of the American College of Cardiology 2013-10, Vol.62 (18), p.1694-1701
• Main Authors: Lazzarino, Antonio I., MD, MSc, Hamer, Mark, PhD, Gaze, David, PhD, Collinson, Paul, MD, Steptoe, Andrew, DSc
• Format: Article
• Language: English
• Subjects: Aged; atherosclerotic plaque; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Cardiology; Cardiology. Vascular system; Cardiovascular; Clinical Research; computed tomography; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Cross-Sectional Studies; Female; Heart; Heart attacks; Humans; Hydrocortisone - analysis; Internal Medicine; Logistic Models; Male; Medical sciences; Middle Aged; Mortality; myocardial infarction; Older people; Pharmacology. Drug treatments; Plasma; psychological stress; Saliva - chemistry; Stress; Stress, Psychological - metabolism; Tomography, X-Ray Computed; troponin T; Troponin T - blood
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.05.070

Objectives The objective of this study was to examine the association between cortisol response to mental stress and high-sensitivity cardiac troponin T (hs-cTnT) in healthy older individuals without history of cardiovascular disease (CVD). Background Mental stress is a recognized risk factor for CVD, although the mechanisms remain unclear. Cortisol, a key stress hormone, is associated with coronary atherosclerosis and may accentuate structural and functional cardiac disease. Methods This cross-sectional study involved 508 disease-free men and women aged 53 to 76 years drawn from the Whitehall II epidemiological cohort. We evaluated salivary cortisol response to standardized mental stress tests (exposure) and hs-cTnT plasma concentration using a high-sensitivity assay (outcome). We measured coronary calcification using electron-beam dual-source computed tomography and Agatston scores. Results After adjustment for demographic and clinical variables associated with CVD as well as for inflammatory factors, we found a robust association between cortisol response and detectable hs-cTnT (odds ratio [OR]: 3.98; 95% confidence interval [CI]: 1.60 to 9.92; p = 0.003). The association remained when we restricted the analysis to participants without coronary calcification (n = 222; OR: 4.77; 95% CI: 1.22 to 18.72; p = 0.025) or when we further adjusted for coronary calcification in participants with positive Agatston scores (n = 286; OR: 7.39; 95% CI: 2.22 to 26.24; p = 0.001). Conclusions We found that heightened cortisol response to mental stress was associated with detectable plasma levels of cTnT using high-sensitivity assays in healthy participants, independently of coronary atherosclerosis. Further research is needed to understand the role of psychosocial stress in the pathophysiology of cardiac cell damage.