This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Google Scholar Articles by Dekker, M. J. H. J. Articles by Tiemeier, H. PubMed PubMed Citation Articles by Dekker, M. J. H. J. Articles by Tiemeier, H. Related Collections Adrenal and Hypertension Cardiovascular Endocrinology

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.