Relative hypocortisolism is associated with obesity and the metabolic syndrome in recurrent affective disorders
Martin Maripuu1, Mikael Wikgren1, Pontus Karling2
1Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
Insights
Hypocortisolism, a state of low cortisol, is linked to increased cardiovascular disease risks in affective disorders. This suggests chronic stress may drive metabolic issues and mortality in these patients.
Area of Science:
- Endocrinology
- Psychiatry
- Cardiology
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in affective disorders.
- Affective disorders are linked to CVD risk factors like obesity and metabolic syndrome.
- Chronic stress and hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity may lead to hypocortisolism.
Purpose of the Study:
- To investigate the association between hypocortisolism and metabolic status in patients with recurrent affective disorders.
- To determine if hypocortisolism is linked to cardiovascular risk factors in these patients.
Main Methods:
- A low-dose dexamethasone-suppression-test (DST) was used to assess hypocortisolism.
- 245 patients with recurrent depression or bipolar disorder and 258 controls underwent DST and metabolic assessment.
Main Results:
- Patients with hypocortisolism showed significantly higher odds of obesity, overweight, large waist, high LDL, low HDL, and metabolic syndrome.
- Similar, though less pronounced, patterns were observed in the control group.
- Increased odds ratios were noted for obesity (OR=4.0), high LDL (OR=4.2), and metabolic syndrome (OR=2.0) in patients with hypocortisolism.
Conclusions:
- Hypocortisolism is associated with a substantial portion of metabolic disorders and CVD risk factors in affective disorders.
- Long-term stress contributing to hypocortisolism may be a central factor in metabolic abnormalities and CVD mortality.
- Findings highlight the link between stress, hypocortisolism, and cardiovascular health in recurrent affective disorders.
Background:
Cardiovascular disease (CVD) is one of the main causes of excess deaths in affective disorders. Affective disorders are associated with increased frequencies of CVD risk-factors such as obesity, dyslipidemia, and metabolic syndrome. Stress-induced chronic cortisol excess has been suggested to promote obesity and metabolic syndrome. Chronic stress with frequent or persisting hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity may, over time, lead to a state of low HPA-axis activity, also denoted hypocortisolism. A low-dose weight-adjusted dexamethasone-suppression-test (DST) is considered to be a sensitive measure of hypocortisolism.
Methods:
245 patients with recurrent depression or bipolar disorder and 258 controls participated in a low-dose DST and were also examined with regard to metabolic status.
Results:
Patients with hypocortisolism (low post-DST cortisol) compared with patients without hypocortisolism (normal or high post-DST cortisol) exhibited increased odds ratios (OR) for obesity (OR=4.0), overweight (OR=4.0), large waist (OR=2.7), high LDL (OR=4.2), low HDL (OR=2.4), high LDL/HDL ratio (OR=3.3), high TC/HDL ratio (OR=3.4) and metabolic syndrome (OR=2.0). A similar pattern but less pronounced was also found in the control sample.
Limitations:
The cross sectional study design and absence of analyses addressing lifestyle factors.
Conclusions:
Our findings suggest that a substantial portion of the metabolic disorders and cardiovascular risk factors seen in recurrent affective disorders are found among individuals exhibiting hypocortisolism. This might indicate that long-term stress is a central contributor to metabolic abnormalities and CVD mortality in recurrent affective disorders.
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