Background: Coronary heart disease (CHD) and its major risk factor hypertension have both been associated with altered activity of the hypothalamus-pituitary-adrenal (HPA)-axis but the biological mechanisms underlying prospective associations with adverse disease outcomes are unclear. We investigated diurnal HPA-axis activity in CHD-patients, hypertensive (HT) and healthy normotensive men (NT) and tested for prospective associations with biological CHD risk factors.

Methods: Eighty-three male CHD-patients, 54 HT and 54 NT men repeatedly measured salivary cortisol over two consecutive days. Prospective CHD risk was assessed by changes between baseline and follow-up in the prothrombotic factors D-dimer and fibrinogen, the pro-inflammatory measures interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and acute phase protein C-reactive protein (CRP), as well as blood lipids in terms of total cholesterol (tChol)/high-density-lipoprotein cholesterol (HDL)-ratio. We aggregated coagulation and inflammatory measures to respective indices.

Results: The groups differed in repeated daytime cortisol (dayCort) secretion (=.005,η =.03,=0.18) and cortisol awakening response (CAR) (=.006,η =.03,=0.18), with similarly lower overall dayCort and CAR in CHD-patients and HT, as compared to NT. The groups differed further in cortisol at awakening (=.015,η =.04,=0.20) with highest levels in HT (´s≤.050), and in diurnal slope between waking and evening cortisol (=.033,η =.04,=0.20) with steepest slopes in HT (´s≤.039), although in part not independent of confounders. Lower aggregated dayCort and CAR in terms of area-under-the-curve (AUC) independently predicted increases in future overall CHD risk (AUC: =.021,η =.10,=0.33;AUC: =.028,η =.09,=0.31) 3.00 ± 0.06() years later, with risk prediction most pronounced in fibrinogen (AUC: =.017,Δ = 0.12;AUC: =.082).

Conclusion: We found evidence for an HPA-axis hypoactivity in CHD and HT with lower diurnal HPA-axis activity predicting increases in cardiovascular risk as evidenced by increases in circulating levels of biomarkers of atherothrombotic risk. Down-regulation of basal HPA-axis activity may contribute to the pathogenesis of atherosclerosis and thrombosis in CHD effects on coagulation.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036761PMC
http://dx.doi.org/10.3389/fendo.2023.1080938DOI Listing

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