Stress hormones at rest and following exercise testing predict coronary artery disease severity and outcome

Popovic D, Damjanovic S, Djordjevic T, Martic D, Ignjatovic S,
Milinkovic N, Banovic M, Lasica R, Petrovic M, Guazzi M, Arena

Stress. 2017 Sep;20(5):523-531.

OBJECTIVES: Despite considerable knowledge regarding the importance of stress in
coronary artery disease (CAD) pathogenesis, its underestimation persists in
routine clinical practice, in part attributable to lack of a standardized,
objective assessment. The current study examined the ability of stress hormones
to predict CAD severity and prognosis at basal conditions as well as during and
following an exertional stimulus.
MATERIALS AND METHODS: Forty Caucasian subjects with significant coronary artery
lesions (≥50%) were included. Within 2 months of coronary angiography,
cardiopulmonary exercise testing (CPET) on a recumbent ergometer was performed in
conjunction with stress echocardiography (SE). At rest, peak and after 3 min of
recovery following CPET, plasma levels of cortisol, adrenocorticotropic hormone
(ACTH) and NT-pro-brain natriuretic peptide (NT-pro-BNP) were measured by
immunoassay sandwich technique, radioimmunoassay, and radioimmunometric
technique, respectively. Subjects were subsequently followed a mean of
32 ± 10 months.
RESULTS AND DISCUSSION: Mean ejection fraction was 56.7 ± 9.6%. Subjects with 1-2
stenotic coronary arteries (SCA) demonstrated a significantly lower plasma
cortisol levels during CPET compared to those with 3-SCA (p < .05), whereas ACTH
and NT-pro-BNP were not significantly different (p > .05). Among CPET, SE, and
hormonal parameters, cortisol at rest and during CPET recovery demonstrated the
best predictive value in distinguishing between 1-, 2-, and 3-SCA [area under ROC
curve 0.75 and 0.77 (SE = 0.11, 0.10; p = .043, .04) for rest and recovery,
respectively]. ΔCortisol peak/rest predicted cumulative cardiac events (area
under ROC curve 0.75, SE = 0.10, p = .049).
CONCLUSIONS: Cortisol at rest and following an exercise test holds predictive
value for CAD severity and prognosis, further demonstrating a link between stress
and unwanted cardiac events.