Vol 26, No 5 (2019)
Original articles — Clinical cardiology
Published online: 2017-10-18

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Morning and afternoon serum cortisol level in patients with post-myocardial infarction depression

Alina Wilkowska1, Andrzej Rynkiewicz2, Joanna Wdowczyk3, Jerzy Landowski1
Pubmed: 29064538
Cardiol J 2019;26(5):550-554.

Abstract

Background: Post-myocardial depression is a highly prevalent condition which worsens the course and prognosis of coronary artery disease. One possible pathogenetic factor is dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in cortisol profile disturbances. Methods: Thirty seven patients hospitalized due to a first myocardial infarction (MI) were enrolled in this study. The Beck Depression Inventory (BDI) was used to rate the severity of their depressive symptoms. Morning and afternoon serum cortisol samples were taken on the fifth day of the MI. Results: Depression, defined as BDI ≥ 10, was present in 34.4% of the patients. A statistically significant difference was observed between the mean morning and the evening plasma concentrations in patients with depression compared to the no-depression group: F (1.29) = 5.0405, p = 0.0328. Conclusions: Patients with depressive symptoms directly after MI have a flattened diurnal serum cortisol profile. This is particularly expressed in patients with longer lasting symptoms.

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References

  1. Green LA, Dickinson WP, Nease DE, et al. AAFP guideline for the detection and management of post-myocardial infarction depression. The Annals of Family Medicine. 2009; 7(1): 71–79.
  2. Vollmer-Conna U, Cvejic E, Granville Smith I, et al. Characterising acute coronary syndrome-associated depression: Let the data speak. Brain Behav Immun. 2015; 48: 19–28.
  3. Steptoe A, Wikman A, Molloy GJ, et al. Inflammation and symptoms of depression and anxiety in patients with acute coronary heart disease. Brain Behav Immun. 2013; 31: 183–188.
  4. de Jonge P, Rosmalen JGM, Kema IP, et al. Psychophysiological biomarkers explaining the association between depression and prognosis in coronary artery patients: a critical review of the literature. Neurosci Biobehav Rev. 2010; 35(1): 84–90.
  5. Cubała WJ, Landowski J. C-reactive protein and cortisol in drug-naïve patients with short-illness-duration first episode major depressive disorder: possible role of cortisol immunomodulatory action at early stage of the disease. J Affect Disord. 2014; 152-154: 534–537.
  6. Ter Horst GJ. Central autonomic control of the heart, angina, and pathogenic mechanisms of post-myocardial infarction depression. Eur J Morphol. 1999; 37(4-5): 257–266.
  7. Granville Smith I, Parker G, Cvejic E, et al. Acute coronary syndrome-associated depression: the salience of a sickness response analogy? Brain Behav Immun. 2015; 49: 18–24.
  8. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders. American Psychiatric Press, Inc, Washington 2005: DC.
  9. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561–571.
  10. Myers V, Gerber Y, Benyamini Y, et al. Post-myocardial infarction depression: increased hospital admissions and reduced adoption of secondary prevention measures: a longitudinal study. J Psychosom Res. 2012; 72(1): 5–10.
  11. Meurs M, Zuidersma M, Dickens C, et al. Examining the relation between post myocardial infarction depression and cardiovascular prognosis using a validated prediction model for post myocardial mortality. Int J Cardiol. 2013; 167(6): 2533–2538.
  12. Zuidersma M, Thombs BD, de Jonge P. Onset and recurrence of depression as predictors of cardiovascular prognosis in depressed acute coronary syndrome patients: a systematic review. Psychother Psychosom. 2011; 80(4): 227–237.
  13. Meijer A, Conradi HJ, Bos EH, et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research. Gen Hosp Psychiatry. 2011; 33(3): 203–216.
  14. Zuidersma M, Conradi HJ, van Melle JP, et al. Self-reported depressive symptoms, diagnosed clinical depression and cardiac morbidity and mortality after myocardial infarction. Int J Cardiol. 2013; 167(6): 2775–2780.
  15. Chopra MP, Thadani U, Aber CP, et al. Plasma cortisol, urinary 17-hydroxycorticoids, and urinary vanilyl mandelic acid after acute myocardial infarction. Heart. 1972; 34(10): 992–997.
  16. Donald RA, Crozier IG, Foy SG, et al. Plasma corticotrophin releasing hormone, vasopressin, ACTH and cortisol responses to acute myocardial infarction. Clin Endocrinol (Oxf). 1994; 40(4): 499–504.
  17. Whitehead DL, Perkins-Porras L, Strike PC, et al. Cortisol awakening response is elevated in acute coronary syndrome patients with type-D personality. J Psychosom Res. 2007; 62(4): 419–425.
  18. Burke HM, Davis MC, Otte C, et al. Depression and cortisol responses to psychological stress: a meta-analysis. Psychoneuroendocrinology. 2005; 30(9): 846–856.
  19. Doane LD, Mineka S, Zinbarg RE, et al. Are flatter diurnal cortisol rhythms associated with major depression and anxiety disorders in late adolescence? The role of life stress and daily negative emotion. Dev Psychopathol. 2013; 25(3): 629–642.
  20. Adam EK, Hawkley LC, Kudielka BM, et al. Day-to-day dynamics of experience--cortisol associations in a population-based sample of older adults. Proc Natl Acad Sci U S A. 2006; 103(45): 17058–17063.
  21. Sjögren E, Leanderson P, Kristenson M. Diurnal saliva cortisol levels and relations to psychosocial factors in a population sample of middle-aged Swedish men and women. Int J Behav Med. 2006; 13(3): 193–200.
  22. Bhattacharyya MR, Molloy GJ, Steptoe A. Depression is associated with flatter cortisol rhythms in patients with coronary artery disease. J Psychosom Res. 2008; 65(2): 107–113.
  23. Ronaldson A, Kidd T, Poole L, et al. Diurnal cortisol rhythm is associated with adverse cardiac events and mortality in coronary artery bypass patients. J Clin Endocrinol Metab. 2015; 100(10): 3676–3682.
  24. Johar H, Emeny RT, Bidlingmaier M, et al. Lower morning to evening cortisol ratio is associated with cognitive impairment in men but not women: An analysis of 733 older subjects of the cross-sectional KORA-Age study. Psychoneuroendocrinology. 2015; 51: 296–306.