Poor mental health, cortisol reactivity and risk of subclinical coronary calcification

  • Ms Adrie Seldenrijk, VU University Medical Center, Amsterdam, The Netherlands
  • Dr Mark Hamer, University College London, United Kingdom
  • Prof Brenda Penninx, VU University Medical Center, Amsterdam, The Netherlands
  • Prof Andrew Steptoe, University College London, United Kingdom

Objective: Poor mental health has been associated with coronary heart disease (CHD). One of the hypothesized mechanisms is HPA-axis dysfunction, which has been shown to increase the risk of coronary artery calcification (CAC). We examined the association between poor mental health (current or chronic), cortisol response to laboratory-induced mental stress and subclinical coronary atherosclerosis.

Methods: Participants were 527 CHD-free men and women (mean age = 63.0 ± 5.7 years) without a history of depression, drawn from the Whitehall II epidemiological cohort. CAC was measured using electron beam computed tomography. Mental health was assessed using the Short Form-36 Mental Health subscale at time of the heart scan (current) and additionally five times over 15 years preceding the heart scan (chronic). Salivary cortisol was measured in response to mental stressors (Stroop, mirror tracing).

Results: Detectable CAC (some: Agatston score 1-399; severe: Agatston score ≥ 400) was found in 56.4% of the sample. Mean mental health scores were 79.6 ± 14.1 (current) and 77.4 ± 12.1 (chronic). 40.0% of the participants responded to the stress tasks with a marked (≥ 1 nmol/l) increase in cortisol. After adjustment for sociodemographic and conventional risk factors, chronic but not current poor mental health was associated with a higher risk of severe CAC (ORsevere per SD decrease = 1.48, 95%CI: 1.03-2.13; log Agatston score per SD decrease 0.25 ± 0.11, p=.02 within detectable CAC subpopulation). Poor mental health was associated with a blunted cortisol response (per SD decrease: βcurrent = -.06, p=.01; βchronic = -.05, p=.03). However, there tended to be a significant interaction between chronic poor mental health and cortisol response (p = .097) in predicting severe CAC. Participants in the lowest mood quartile (poorest mental health) who were classified as cortisol responders showed the highest prevalence.

Conclusions: In healthy, older participants, chronic but not current poor mental health is associated with CAC. Participants with poor mental health generally showed blunted cortisol responses, while those (atypically) with higher cortisol responsiveness were at higher risk for severe CAC. Persons with ‘hypercortisolemic low mood’ in particular might carry risk for CHD.