High hair cortisol foreshadows acute myocardial infarction

Patients who had suffered an episode of acute myocardial infarction (AMI) appear to show heightened levels of hair cortisol, indicative of biological stress, in the preceding month, a recent study has found.

The study included 174 AMI patients (73.0 percent male), in whom the median hair cortisol concentration (HCC) was measured using a competitive radioimmunoassay. A parallel group of 3,156 population-based controls (36.3 percent male) was also included.

Median HCC was significantly higher for the AMI patients than the controls (53.2 vs 22.2 pg/mg; p<0.001). This trend remained true even when stratifying the participants according to sex (males: 57.8 vs 25.9 pg/mg; females: 46.6 vs 20.1 pg/mg; p<0.001 for both). When AMI patients on glucocorticoids were eliminated from the analysis, median HCC was only slightly lowered.

The log₁₀ of hair cortisol was able to statistically differentiate between AMI patients and controls both in males (odds ratio [OR], 1.70, 95 percent confidence interval [CI], 1.47–1.95; p<0.001) and females (OR, 1.70, 95 percent CI, 1.37–2.12; p<0.001).

Categorizing patients according to quintiles of HCC revealed that its interaction with AMI risk is not linear. Risk estimates increased only modestly in the first three quintiles, and grew explosively in the top two categories.

Multivariate logistic regression analysis confirmed that participants in the two highest quintiles of HCC saw a significantly greater risk of AMI (OR, 5.04, 95 percent CI, 3.12–8.16; p<0.001). Other notable risk factors included a clinical or family history of myocardial infarction and having had prior cardiovascular and/or cerebrovascular disease.