Association Between Serum Cortisol Levels and Variant Angina

Variant angina (VA) is caused by coronary vasospasm, and psychological stress has been suggested as a potential trigger. However, the clinical association between cortisol, a key stress hormone, and VA is unclear. This study aimed to evaluate the relationship between serum cortisol levels and VA.

In this prospective single-center study, 192 patients undergoing coronary angiography between October 2022 and August 2023 were enrolled. Patients were categorized into normal coronaries, VA, stable angina, and acute coronary syndrome. Serum cortisol, norepinephrine, and adrenocorticotropic hormone (ACTH) were measured at standardized time points, including admission and one day post-angiography. Multivariable logistic regression was performed to identify independent factors associated with VA.

Among the 192 patients, 23 (12.0%) were diagnosed with VA. Compared with the normal group, the VA group showed higher cortisol levels at admission (9.7±3.5 vs. 7.9±4.2 µg/dL, p=0.04) and on day 1 (10.1±3.4 vs. 8.3±4.3 µg/dL, p=0.04), whereas ACTH and norepinephrine levels did not differ significantly. In multivariable logistic regression comparing VA with normal coronaries, higher admission cortisol remained independently associated with VA, along with younger age and lower C-reactive protein levels. Subgroup analyses showed that sampling time, admission route, and percutaneous coronary intervention status did not influence stress hormone levels.

Patients with VA exhibited elevated cortisol during the acute phase compared with those with normal coronaries, independent of baseline characteristics. These findings suggest an association between stress-related cortisol elevation and coronary vasospasm and highlight the need for further clinical research.