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European Heart Journal Advance Access published online on September 10, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp386
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Salivary cortisol responses to mental stress are associated with coronary artery calcification in healthy men and women

Mark Hamer1,*, Katie O'Donnell1, Avijit Lahiri2 and Andrew Steptoe1

1 Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
2 Cardiac Imaging and Research Centre, Wellington Hospital, London, UK

Received 9 April 2009; revised 21 August 2009; accepted 26 August 2009 * Corresponding author. Tel: +44 20 7679 5969, Fax: +44 20 7916 8542, Email: m.hamer{at}ucl.ac.uk

Aims: Psychosocial stress is a risk factor for coronary heart disease (CHD), although the mechanisms are incompletely understood. We examined the cross-sectional association between the cortisol response to laboratory-induced mental stress and a marker of sub-clinical coronary atherosclerosis.

Methods and results: Participants were 514 healthy men and women (mean age = 62.9 ± 5.7 years), without history or objective signs of CHD, drawn from the Whitehall II epidemiological cohort. Salivary cortisol was measured in response to mental stressors, consisting of a 5 min Stroop task and a 5 min mirror tracing task. Coronary artery calcification (CAC) was measured using electron beam computed tomography. Approximately 40% of the sample responded to the stress tasks with a notable (≥1 nmol/L) increase in cortisol. Significant CAC (Agatston score ≥ 100) was recorded in 23.9% of the sample. The cortisol response group demonstrated a higher risk of significant CAC (odds ratio = 2.20, 95% CI, 1.39–3.47) after adjustments for age, gender, baseline cortisol, employment grade, and conventional risk factors, although cortisol was unrelated to the presence of detectable CAC. Among participants with detectable CAC, the cortisol response group also demonstrated higher log Agatston scores compared with non-responders (age and sex adjusted scores; 4.51 ± 0.15 vs. 3.94 ± 0.13, P = 0.004).

Conclusion: In healthy, older participants without history or objective signs of CHD, heightened cortisol reactivity is associated with a greater extent of CAC. These data support the notion that heightened hypothalamic pituitary adrenal activity is a risk factor for CHD.

Key Words: Mental stress • Psychophysiology • HPA axis • Sub-clinical atherosclerosis • Electron beam computed tomography


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