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Published on: September 15, 2017
Daytime plasma cortisol and cortisol response to dexamethasone suppression are associated with a prothrombotic state
Gabriele Brosolo1, Andrea Da Porto2, Luca Bulfone1
1Internal Medicine and European Hypertension Excellence Center, Department of Medicine, University of Udine, Udine, Italy.
Insights
Elevated cortisol levels and stress responses are linked to a prothrombotic state in hypertensive patients. This suggests a higher risk for organ damage and cardiovascular complications in individuals with hypertension.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Hematology
Background:
- Hypertension is associated with a prothrombotic state, contributing to cardiovascular and renal damage.
- Cushing's syndrome, characterized by excess cortisol, is known to induce a prothrombotic state.
Purpose of the Study:
- To investigate the relationship between cortisol secretion and hemostatic/fibrinolytic systems in hypertensive patients.
- To determine if cortisol profiles and responses are associated with prothrombotic markers in hypertension.
Main Methods:
- 149 non-diabetic, essential hypertensive patients without cardiovascular/renal complications were studied.
- Hemostatic markers (D-dimer, F1+2, vWF) and daily cortisol levels (AUC-cortisol) were measured.
- Cortisol response to dexamethasone overnight suppression (DST-cortisol) was assessed.
Main Results:
- Plasma D-dimer, F1+2, and vWF levels increased significantly with higher AUC-cortisol and DST-cortisol.
- These prothrombotic markers correlated directly with age and cortisol measures.
- Cortisol measures remained significant predictors of prothrombotic markers, independent of age, BMI, blood pressure, and renal function.
Conclusions:
- Higher daily cortisol profiles and stress responses are independently linked to a prothrombotic state in hypertensive individuals.
- These findings suggest a potential mechanism for organ damage and increased cardiovascular risk in hypertension.
Background And Aims:
A prothrombotic state was demonstrated in patients with Cushing's syndrome and is involved in the development and progression of cardiovascular and renal damage in hypertensive patients. This study was designed to examine the relationships between cortisol secretion and the hemostatic and fibrinolytic systems in hypertension.
Methods:
In 149 middle-aged, nondiabetic, essential hypertensive patients free of cardiovascular and renal complications, we measured hemostatic markers that express the spontaneous activation of the coagulation and fibrinolytic systems and assessed daily cortisol levels (8 AM, 3 PM, 12 AM; area under the curve, AUC-cortisol) together with the cortisol response to dexamethasone overnight suppression (DST-cortisol).
Results:
Plasma levels of D-dimer (D-dim), prothrombin fragment 1 + 2 (F1 + 2), and von Willebrand factor (vWF) were progressively and significantly higher across tertiles of AUC-cortisol and DST-cortisol, whereas no differences were observed in fibrinogen, tissue plasminogen activator, plasminogen activator inhibitor-1, antithrombin III, protein C, and protein S. D-dim, F1 + 2, and vWF were significantly and directly correlated with age and both AUC-cortisol and DST-cortisol. Multivariate regression analysis showed that both AUC-cortisol and DST-cortisol were related to plasma D-dim, F1 + 2, and vWF independently of age, body mass index, blood pressure, and renal function.
Conclusion:
Greater daily cortisol profile and cortisol response to overnight suppression are independently associated with a prothrombotic state in hypertensive patients and might contribute to the development of organ damage and higher risk of cardiovascular complications.
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