Increased left ventricular mass in hypercortisolemic depressed patients: a hypothesis based on a case series

Hypercortisolemia in depressed patients is known to be related to changes in body composition, especially increased ectopic fat and lowered bone mineral density. Both hypercortisolemia in patients with Cushing's disease and depression in patients undergoing treatment with hemodialysis have been shown to be associated with increased left ventricular mass.

Increased activity of the hypothalamus-pituitary-adrenal (HPA) system in depressed patients is related to high left ventricular mass.

To corroborate our hypothesis, we measured left ventricular mass in 5 depressed patients with clear evidence for HPA system activation (nonsuppression in dexamethasone suppression test [DST]; increased 24 h cortisol excretion) and 27 healthy controls. We found increased left ventricular mass in hypercortisolemic depressed patients compared to healthy controls (343±97 vs. 176±57 gr; p=0.007).

Depression is known to be related to an increased risk of cardial morbidity and mortality, although the risk architecture is not completely understood. We hypothesize that hypercortisolemic depression is associated with increased left ventricular mass, which is known to be a strong predictor for cardial mortality. Thus, a potential effect of activated stress-responsive systems on heart morphology may contribute to depressed patients' increased cardiovascular risk.