Levels of stress homone - cortisol significantly increases death rate in patients with acute coronary syndrome

Growing evidence suggests that serumThe clear fluid that separates from blood when it clots. It contains salts, glucose and proteins. cortisolA steroid hormone important for helping to regulate carbohydrate metabolism and the stress response. levels are associated with increased cardiovascular mortality in patients with chronicA disease of long duration generally involving slow changes. heart failureFailure of the heart to pump adequately., research presented at this week’s European Congress of Endocrinology shows.

Until now, the significance of cortisol levels in patients with acute coronary syndromeA range of clinical conditions caused by coronary artery disease: it encompasses the full spectrum from unstable angina to heart attack. (ACS) has been unknown.  Cortisol is a hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. produced by the adrenal glandOne of a pair of small, triangular shaped glands located above each kidney..  Amongst other actions, it modifies our reactions to stressRelating to injury or concern. and anxiety, regulates blood pressureThe pressure of blood within the arteries. and helps to keep bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar levels within normal ranges.  Now a group of researchers headed by Dr Andreas Tomaschitz at the Medical University of Graz-Austria  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 geneticRelating to the genes, the basic units of genetic material. and other biological traits on the cardiovascular systemThe body system consisting of the heart and blood vessels..  The study has enrolled over 3000 participants for coronary angiographyA technique for X-ray imaging of the coronary arteries, which involves introducing a catheter through a blood vessel and threading it towards the heart, then injecting a contrast medium to improve visibility. at the Herzzentrum, Ludwigshafen, Germany.

For this work, 1036 patients with acuteHas a sudden onset. 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).

Lead researcher, Dr Andreas Tomaschitz, said: “In the future we will need to understand the complex way in which cells react to cortisol, and how this causes cardiovascular damage to people with acute coronary syndrome.”

Definitions

Acute coronary syndrome (ACS) is a term that doctors use to describe a range of problems that can be caused by a sudden reduction in blood flow to the heart muscleTissue made up of cells that can contract to bring about movement. caused by a narrowing or blockage of the blood vessels.  This group of problems ranges from a threatened heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. (unstable anginaChest pain caused by poor blood supply to the heart that comes on unpredictably - not just during exercise.) to an actual heart attack (myocardial infarctionDeath of an area of heart muscle due to poor blood supply. This is commonly known as a heart attack.).

Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through your heart.

See ‘Chest Pain – Cardiac or not’ by Professor Lahiri for plain English guidance on latest recommended cardiac assessment.