Elevated Fasting Plasma Cortisol Is Associated with Ischemic Heart Disease and Its Risk Factors in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study

ET2DS Investigators; Rebecca M. Reynolds; Javier Labad; Mark W. J. Strachan; Anke Braun; F. Gerry R. Fowkes; Amanda J. Lee; Brian M. Frier; Jonathan R. Seckl; Brian R. Walker; Jackie F. Price

doi:10.1210/jc.2009-2112

Elevated Fasting Plasma Cortisol Is Associated with Ischemic Heart Disease and Its Risk Factors in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study

ET2DS Investigators, Rebecca M. Reynolds, Javier Labad, Mark W. J. Strachan, Anke Braun, F. Gerry R. Fowkes, Amanda J. Lee, Brian M. Frier, Jonathan R. Seckl, Brian R. Walker, Jackie F. Price

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

Context: Increased activity of the hypothalamic-pituitary-adrenal (HPA) axis may underlie the metabolic syndrome, but whether circulating cortisol levels predict cardiovascular end points is less clear. People with type 2 diabetes are at increased cardiovascular disease risk and thus are suitable to study associations of plasma cortisol with cardiovascular risk.

Objective: We aimed to assess whether altered HPA axis activity was associated with features of the metabolic syndrome and ischemic heart disease in people with type 2 diabetes.

Design and Setting: We conducted a cross-sectional cohort study in the general community, including 919 men and women aged 67.9 (4.2) yr with type 2 diabetes (the Edinburgh Type 2 Diabetes Study).

Intervention: We measured fasting morning plasma cortisol.

Main Outcome Measurement: Associations between cortisol levels, features of the metabolic syndrome, obesity, and ischemic heart disease were determined.

Results: Elevated plasma cortisol levels were associated with raised fasting glucose and total cholesterol levels (P < 0.001). These findings remained significant after adjustment for potential confounding factors (P < 0.001). Elevated cortisol levels were associated with prevalent ischemic heart disease (>800 vs. <600 nmol/liter; odds ratio, 1.58; P = 0.02). This association remained significant after adjustment for duration and control of diabetes and other cardiovascular risk factors (P = 0.03).

Conclusions: The previously described associations between HPA axis activation and features of the metabolic syndrome are present among people with type 2 diabetes. Elevated plasma cortisol is also associated with a greater prevalence of ischemic heart disease, independent of conventional risk factors. Understanding the role of cortisol in the pathogenesis of ischemic heart disease merits further exploration. (J Clin Endocrinol Metab 95: 1602-1608, 2010)

Original language	English
Pages (from-to)	1602-1608
Number of pages	7
Journal	The Journal of Clinical Endocrinology & Metabolism (JCEM)
Volume	95
Issue number	4
DOIs	https://doi.org/10.1210/jc.2009-2112
Publication status	Published - Apr 2010

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ET2DS Investigators, Reynolds, R. M., Labad, J., Strachan, M. W. J., Braun, A., Fowkes, F. G. R., Lee, A. J., Frier, B. M., Seckl, J. R., Walker, B. R., & Price, J. F. (2010). Elevated Fasting Plasma Cortisol Is Associated with Ischemic Heart Disease and Its Risk Factors in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study. The Journal of Clinical Endocrinology & Metabolism (JCEM), 95(4), 1602-1608. https://doi.org/10.1210/jc.2009-2112

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title = "Elevated Fasting Plasma Cortisol Is Associated with Ischemic Heart Disease and Its Risk Factors in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study",

abstract = "Context: Increased activity of the hypothalamic-pituitary-adrenal (HPA) axis may underlie the metabolic syndrome, but whether circulating cortisol levels predict cardiovascular end points is less clear. People with type 2 diabetes are at increased cardiovascular disease risk and thus are suitable to study associations of plasma cortisol with cardiovascular risk.Objective: We aimed to assess whether altered HPA axis activity was associated with features of the metabolic syndrome and ischemic heart disease in people with type 2 diabetes.Design and Setting: We conducted a cross-sectional cohort study in the general community, including 919 men and women aged 67.9 (4.2) yr with type 2 diabetes (the Edinburgh Type 2 Diabetes Study).Intervention: We measured fasting morning plasma cortisol.Main Outcome Measurement: Associations between cortisol levels, features of the metabolic syndrome, obesity, and ischemic heart disease were determined.Results: Elevated plasma cortisol levels were associated with raised fasting glucose and total cholesterol levels (P < 0.001). These findings remained significant after adjustment for potential confounding factors (P < 0.001). Elevated cortisol levels were associated with prevalent ischemic heart disease (>800 vs. <600 nmol/liter; odds ratio, 1.58; P = 0.02). This association remained significant after adjustment for duration and control of diabetes and other cardiovascular risk factors (P = 0.03).Conclusions: The previously described associations between HPA axis activation and features of the metabolic syndrome are present among people with type 2 diabetes. Elevated plasma cortisol is also associated with a greater prevalence of ischemic heart disease, independent of conventional risk factors. Understanding the role of cortisol in the pathogenesis of ischemic heart disease merits further exploration. (J Clin Endocrinol Metab 95: 1602-1608, 2010)",

author = "{ET2DS Investigators} and Reynolds, {Rebecca M.} and Javier Labad and Strachan, {Mark W. J.} and Anke Braun and Fowkes, {F. Gerry R.} and Lee, {Amanda J.} and Frier, {Brian M.} and Seckl, {Jonathan R.} and Walker, {Brian R.} and Price, {Jackie F.}",

year = "2010",

month = apr,

doi = "10.1210/jc.2009-2112",

language = "English",

volume = "95",

pages = "1602--1608",

journal = "The Journal of Clinical Endocrinology & Metabolism (JCEM)",

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ET2DS Investigators, Reynolds, RM, Labad, J, Strachan, MWJ, Braun, A, Fowkes, FGR, Lee, AJ, Frier, BM, Seckl, JR, Walker, BR & Price, JF 2010, 'Elevated Fasting Plasma Cortisol Is Associated with Ischemic Heart Disease and Its Risk Factors in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study', The Journal of Clinical Endocrinology & Metabolism (JCEM), vol. 95, no. 4, pp. 1602-1608. https://doi.org/10.1210/jc.2009-2112

Elevated Fasting Plasma Cortisol Is Associated with Ischemic Heart Disease and Its Risk Factors in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study. / ET2DS Investigators ; Reynolds, Rebecca M.; Labad, Javier et al.
In: The Journal of Clinical Endocrinology & Metabolism (JCEM), Vol. 95, No. 4, 04.2010, p. 1602-1608.

Research output: Contribution to journal › Article › peer-review

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T1 - Elevated Fasting Plasma Cortisol Is Associated with Ischemic Heart Disease and Its Risk Factors in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study

AU - ET2DS Investigators

AU - Reynolds, Rebecca M.

AU - Labad, Javier

AU - Strachan, Mark W. J.

AU - Braun, Anke

AU - Fowkes, F. Gerry R.

AU - Lee, Amanda J.

AU - Frier, Brian M.

AU - Seckl, Jonathan R.

AU - Walker, Brian R.

AU - Price, Jackie F.

PY - 2010/4

Y1 - 2010/4

N2 - Context: Increased activity of the hypothalamic-pituitary-adrenal (HPA) axis may underlie the metabolic syndrome, but whether circulating cortisol levels predict cardiovascular end points is less clear. People with type 2 diabetes are at increased cardiovascular disease risk and thus are suitable to study associations of plasma cortisol with cardiovascular risk.Objective: We aimed to assess whether altered HPA axis activity was associated with features of the metabolic syndrome and ischemic heart disease in people with type 2 diabetes.Design and Setting: We conducted a cross-sectional cohort study in the general community, including 919 men and women aged 67.9 (4.2) yr with type 2 diabetes (the Edinburgh Type 2 Diabetes Study).Intervention: We measured fasting morning plasma cortisol.Main Outcome Measurement: Associations between cortisol levels, features of the metabolic syndrome, obesity, and ischemic heart disease were determined.Results: Elevated plasma cortisol levels were associated with raised fasting glucose and total cholesterol levels (P < 0.001). These findings remained significant after adjustment for potential confounding factors (P < 0.001). Elevated cortisol levels were associated with prevalent ischemic heart disease (>800 vs. <600 nmol/liter; odds ratio, 1.58; P = 0.02). This association remained significant after adjustment for duration and control of diabetes and other cardiovascular risk factors (P = 0.03).Conclusions: The previously described associations between HPA axis activation and features of the metabolic syndrome are present among people with type 2 diabetes. Elevated plasma cortisol is also associated with a greater prevalence of ischemic heart disease, independent of conventional risk factors. Understanding the role of cortisol in the pathogenesis of ischemic heart disease merits further exploration. (J Clin Endocrinol Metab 95: 1602-1608, 2010)

AB - Context: Increased activity of the hypothalamic-pituitary-adrenal (HPA) axis may underlie the metabolic syndrome, but whether circulating cortisol levels predict cardiovascular end points is less clear. People with type 2 diabetes are at increased cardiovascular disease risk and thus are suitable to study associations of plasma cortisol with cardiovascular risk.Objective: We aimed to assess whether altered HPA axis activity was associated with features of the metabolic syndrome and ischemic heart disease in people with type 2 diabetes.Design and Setting: We conducted a cross-sectional cohort study in the general community, including 919 men and women aged 67.9 (4.2) yr with type 2 diabetes (the Edinburgh Type 2 Diabetes Study).Intervention: We measured fasting morning plasma cortisol.Main Outcome Measurement: Associations between cortisol levels, features of the metabolic syndrome, obesity, and ischemic heart disease were determined.Results: Elevated plasma cortisol levels were associated with raised fasting glucose and total cholesterol levels (P < 0.001). These findings remained significant after adjustment for potential confounding factors (P < 0.001). Elevated cortisol levels were associated with prevalent ischemic heart disease (>800 vs. <600 nmol/liter; odds ratio, 1.58; P = 0.02). This association remained significant after adjustment for duration and control of diabetes and other cardiovascular risk factors (P = 0.03).Conclusions: The previously described associations between HPA axis activation and features of the metabolic syndrome are present among people with type 2 diabetes. Elevated plasma cortisol is also associated with a greater prevalence of ischemic heart disease, independent of conventional risk factors. Understanding the role of cortisol in the pathogenesis of ischemic heart disease merits further exploration. (J Clin Endocrinol Metab 95: 1602-1608, 2010)

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DO - 10.1210/jc.2009-2112

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JO - The Journal of Clinical Endocrinology & Metabolism (JCEM)

JF - The Journal of Clinical Endocrinology & Metabolism (JCEM)

IS - 4

ER -

Elevated Fasting Plasma Cortisol Is Associated with Ischemic Heart Disease and Its Risk Factors in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study

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