Association of cortisol with long-term prognosis in patients with acute myocardial infarction
K.K. KHOLMATOVA, N.A. POLYARUSH, M.Yu. YURYEVA, S.N. IVANOVA, I.V. DVORYASHINA
Northern State Medical University, 51 Troitsky prospect, Arkhangelsk, Russian Federation, 163000
Kholmatova K.K. — Ph. D. (medicine), Associate Professor of the Department of Hospital Therapy and Endocrinology, tel. (8182) 63-28-08, [email protected], ORCID ID: 0000-0002-5240-6470
Polyarush N.A. — Ph. D. (medicine), Associate Professor of the Department of Hospital Therapy and Endocrinology, tel. (8182) 63-29-96, [email protected], ORCID: 0000-0001-9369-5857
Yuryeva M.Yu. — Assistant Lecture of the Department of Hospital Therapy and Endocrinology, tel. +7 (8182) 63-28-08, [email protected], ORCID ID 0000-0003-3864-383X
Ivanova S.N. — Ph. D. (medicine), Associate Professor of the Department of Hospital Therapy and Endocrinology, tel. (8182) 63-29-96, [email protected], ORCID ID: 0000-0003-3959-6588
Dvoryashina I.V. — D. Sc. (medicine), Professor, Head of the Department of Hospital Therapy and Endocrinology, tel. (8182) 63-29-96, [email protected], ORCID ID: 0000-0001-9230-0710
To assess plasma cortisol levels in patients with acute myocardial infarction (AMI) and glucose abnormalities (GA) during stabilized states and to study relationships between cortisol levels and long-term prognosis of AMI.
Material and methods. 360 subjects with AMI (63,6% men) aged 18–80 were examined. Plasma levels of insulin, C-peptide and cortisol during oral glucose tolerance test (OGTT) on the 10th–14th day after OIM, basal levels of apolipoproteins A1, B100, leptin and adiponectin fasting were defined in 113 consecutive patients. Group differences were analyzed by Kruskal-Wallis and χ2 tests. Long-term prognosis was assessed during two-year follow-up period. Logistic regression analysis was used to identify the risk factors of poor prognosis after AMI.
Results. All patients had increased basal level of cortisol (>600 nmol/l) and its decrease during OGGT despite the presence of GA. Patients with hypercortisolaemia had significantly higher levels of basal glycaemia (5,5 (5,05–5,78) vs 5,3 (5,10–5,83) mmol/l, p=0,006) and adipokines (leptin (131,9 (74,3–157,0) vs 127,0 (69,5–162,0) ng/ml, p<0,001) and adiponectin (3,83 (2,61–4,25) vs 3,82 (3,44–4,28) ug/ml, p=0,001). There were significant associations between basal hypercortisolaemia and long-term prognosis of AMI. It was an independent predictor of repeated AMI (OR=2,97, 95% CI=1,16–7,59, p=0,023) with adjustment for previous AMI on admission (p=0,038), glycaemia on admission (p=0,054), and any GA (p=0,475).
The conclusions. Basal cortisol levels were abnormally high in all patients with AMI regardless of the presence of GA. Basal hypercortisolaemia was associated with repeated AMI during two-year follow-up period.
Key words: cortisol, acute myocardial infarction, long-term prognosis.
(For citation: Kholmatova K.K., Polyarush N.A., Yuryeva M.Yu., Ivanova S.N., Ivanova S.N., Dvoryashina I.V. Association of cortisol with long-term prognosis in patients with acute myocardial infarction. Practical Medicine. 2018)
REFERENCES
- Brain R.J. Serum cortisol levels predict infarct size and patient mortality. Int. J. cardiol, 1992, vol. 37, no. 2, pp. 145–50.
- Domanski L. Cortisol levels in blood of persons with acute myocardial ischemia and myocardial infarction. Ann. Acad. Med. Stetin, 1999, vol. 45, pp. 137–155.
- Nito I., Waspadji S., Harun S., Markum H.M.S. Correlation between cortisol level and myocardial infarction mortality among intensive coronary care unit patients during seven days hospitalization. Indones. J. Intern. Med, 2004, vol. 36, pp. 8–14.
- Tenerz A. Basal glucometabolic status has an impact on long-term prognosis following an acute myocardial infarction in non-diabetic patients. J. Intern. Med, 2003, vol. 254, no. 5, pp. 494–503.
- Jutla S.K., Yuyun M.F., Quinn P.A., Ng L.L. Plasma cortisol and prognosis of patients with acute myocardial infarction. J. Cardiovasc. Med. (Hagerstown), 2014, vol. 15, no. 1, pp. 33–41.
- Reynolds R.M., Walker B.R., Haw S., Newby D.E., Mackay D.F. et al. Low serum cortisol predicts early death after acute myocardial infarction. Crit. Care. Med, 2010, vol. 38, no. 3, pp. 973–975.
- Kholmatova K.K., Dvoryashina I.V. The prognostic content of adipocytokines in patients with myocardial infarction and various variants of carbohydrate metabolism disorders. Sakharnyy diabet, 2014, no. 3, pp. 90–95 (in Russ.).
- Kholmatova K.K., Dvoryashina I.V. The prognostic content of blood glucose levels at admission in patients with myocardial infarction. Arkhiv vnutrenney meditsiny, 2014, no. 1 (15), pp. 25–29 (in Russ.).
- Telkova I.L. Insulin-producing function and clinical features of patients with hyperinsulinemia in the long-term (> 5 years) myocardial infarction. Rossiyskiy kardiologicheskiy zhurnal, 2003, no. 1, pp. 56–59 (in Russ.).
- Telkova I.L. Rolʹ giperinsulinemii v razvitii zabolevaniya u bolʹnykh, perenesshikh infarkt miokarda, i vozmozhnosti ee farmakologicheskoy korrektsii (dannye prospektivnogo (>5 let) nablyudeniya): avtoref. dis. … dokt. med. nauk [The role of hyperinsulinemia in the development of the disease in patients after myocardial infarction, and the possibility of its pharmacological correction (data from a prospective (> 5 years) observation). Synopsis of dis. Dr med. sciences]. Tomsk, 2002. 40 p.
- Dutawa A. Hormonal supplementation in endocrine dysfunction in critically ill patients. Pharmacological Reports, 2007, vol. 59, pp. 139–149.
- Golikov P.P. Regulation of the function of glucocorticoid receptors and the activity of angiotensin-converting enzyme. Problemy ehndokrinologii, 1997, no. 4, pp. 51–54 (in Russ.).