AUTHOR=Stomby Andreas , Strömberg Susanna , Theodorsson Elvar , Olsen Faresjö Åshild , Jones Mike , Faresjö Tomas 

TITLE=Standard Modifiable Cardiovascular Risk Factors Mediate the Association Between Elevated Hair Cortisol Concentrations and Coronary Artery Disease

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.765000

DOI=10.3389/fcvm.2021.765000

ISSN=2297-055X

ABSTRACT=Background
Increased cortisol exposure is a risk factor for coronary artery disease (CAD). It is not clear to what degree this risk is independent from the standard modifiable risk factors (SMuRFs) dyslipidemia, hypertension and diabetes.

Aim
To use path analysis to test the direct and indirect association, mediated by SMuRFs, between long-term cortisol levels measured in hair (HCC) and CAD.

Method
Hair was sampled from patients admitted with acute myocardial infarction (n = 203) and a population-based sample without a diagnosis or symptoms of CAD (n = 3134). The HCC was analyzed using radioimmunoassay and all participants reported whether they were diagnosed with or treated for diabetes, hypertension, and hyperlipidemia. Path analysis was used to test to what degree the association between logarithmized (ln) HCC and CAD was direct or indirect, mediated by SMuRFs. 

Results
Participants with CAD had elevated HCC compared to those without (median (IQR): 75.2 (167.1) pg/mg vs. 23.6 (35.0) pg/mg, P < 0.0001). Higher HCC was associated with diabetes, hypertension, and hyperlipidaemia which in turn were associated with CAD. In path models, 80% of the association between ln(HCC) and CAD was mediated by SMuRFs, while the direct path between ln(HCC) and CAD was not statistically significant. 

Conclusion
The SMuRFs diabetes, hyperlipidaemia and hypertension mediate the association between ln(HCC) and CAD. Some association between ln(HCC) and CAD did not operate via the SMuRFs considered, and might have a pathway through atherosclerosis or inflammation.