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Salivary Cortisol Is Related to Atherosclerosis of Carotid Arteries

Departments of Internal Medicine (M.J.H.J.D., J.W.K., M.O.v.A., H.A.P.P., F.H.d.J., S.W.J.L.), of Epidemiology & Biostatistics (M.J.H.J.D., H.A.P.P., A.H., J.C.M.W., H.T.), and of Child and Adolescent Psychiatry (H.T.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Biological Psychology (C.K.), Technical University of Dresden, 01187 Dresden, Germany

Address all correspondence and requests for reprints to: H. Tiemeier, M.D., Ph.D., Department of Epidemiology, Biostatistics, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: h.tiemeier{at}erasmusmc.nl.

Background: Dysregulation of the hypothalamic-pituitary-adrenal axis has been suggested as an independent risk factor for ischemic heart disease. The aim of our study was to evaluate whether two markers of the hypothalamic-pituitary-adrenal axis activity, the level of salivary cortisol and the diurnal salivary cortisol pattern, are associated with atherosclerosis of the carotid arteries in an elderly population.

Methods and Results: A total of 1866 participants of the Rotterdam Study, a population-based cohort study in the elderly, provided four salivary cortisol samples throughout 1 d, and underwent ultrasonography to examine the presence of plaques in the common, internal, and bifurcation sites of both carotid arteries. Two summary measures of the separate cortisol values were computed: area under the curve (AUC), which is a measure of total cortisol exposure while awake; and the slope, which is a measure of diurnal cortisol decline.

Results: Total cortisol exposure while awake (AUC) was associated with higher plaque scores (β = 0.08 per SD of AUC, 95% confidence interval 0.00–0.16; P = 0.04) in a fully adjusted linear regression model. Persons with an AUC in the highest tertile had a higher number of plaques of carotid arteries compared with those in the lowest tertile (3.08 vs. 2.80, 95% confidence interval of difference 0.09–0.48; P = 0.005). There was no relation between diurnal cortisol decline and plaque score.

Conclusion: Our results support the hypothesis that increased total cortisol exposure is independently associated with atherosclerosis of the carotid arteries.