A surprising new study suggested an innovative and perhaps unexpected way to search for signs of looming cardiovascular disease in patient populations: cortisol levels in hair. While this may not make sense to patients right away, cardiologists and other medical researchers have long known that there is a correlation between cortisol (the body's stress hormone) and risk for cardiovascular disease. Interestingly, the cortisol levels of the body are 'recorded' to some extent in hair, which can be examined to determine how the cortisol levels have behaved over time.
In the past, cortisol levels were generally measured using saliva or blood tests, but these exams are essentially nothing more than "snapshots" of the overall cortisol levels present in the body. Stressful events which are not repeated or continued over a long period of time can cause spikes in cortisol, but the level normally drops back down after the unpleasant experience ends. Since scientists seek to understand how prolonged stressors (and their associated cortisol levels) affect cardiovascular disease risk, hair examinations are more appropriate since they allow at least 3 months' time to be studied.
To examine the relationship between elevated cortisol levels over a prolonged period of time and overall cardiovascular disease risk, scientists in the Netherlands performed a study on 283 older Dutch patients with a median age of 75. The researchers took approximately 150 strands of hair from each patient and examined the top 3 cm of growth (representing the past 3 months' exposure to cortisol). The researchers then collected information about coronary heart disease, diabetes, stroke, peripheral artery disease, and other medical conditions from the patients.
While women had overall lower rates of hair cortisol levels, those patients who had the highest cortisol levels had significantly greater risk of cardiovascular disease when compared to those with the lowest cortisol levels (p=0.01). The group with the highest cortisol levels also had significantly increased risk of peripheral aterial disease and diabetes, but no evidence of increased risk of stroke. Surprisingly, diseases not associated with the cardiovascular system showed no relationship to cortisol levels, suggesting that for some reason, cortisol is in particular associated with elevated coronary artery disease risk.
Surprisingly, there were no associations noted between body mass index (BMI) and hair cortisol measurements. The scientists who carried out the study noted that the lack of association between cortisol levels and BMI measurements points to the possibility that body weight is only one component of overall cardiovascular disease risk. At the same time, however, because the study only included 283 patients, it is possible that larger studies might elucidate the findings further or even suggest alternative interpretations for some of the data. It is clear though that cardiovascular disease risk is increased when patients have high cortisol levels, and thus future studies can examine the interaction between these two variables. If scientists can determine the degree to which cortisol affects cardiovascular risk, future diagnostic tools and even therapies can be generated to take cortisol into account. For instance, techniques or treatments aimed at lowering cortisol could be developed, and patients with high levels could be treated before they went on to develop cardiovascular disease or its complications.
For now, the takeaway message for patients is to work on controlling traditional cardiovascular risk factors as well as stress levels. Ironically, the physicians and nurses involved in cardiology jobs and emergency medicine jobs who often treat heart disease and associated problems should also take note, since the high risk environments in which they practice may predispose them to cardiovascular disease despite their medical knowledge. Stress reduction is useful for physicians just as much as it is useful for the patients that physicians treat.
If possible, patients can use relaxation therapies, meditation, acupuncture, or other treatments to reduce the physical responses to daily stressors. Of course, life is full of challenges, and it may never be feasible to eliminate all forms of stress or anxiety. The healthy habits that tend to aid in lower cardiovascular disease risk are also likely to aid in stress reduction, such as exercise, enough sleep, a healthy diet, and a balanced work/life situation. For cardiologists and other physicians, the takeaway message is that future studies should examine the relationship between stress hormones and heart disease risk.
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