Published Online
on September 28, 2009

A more recent version of this article appeared on November 1, 2009

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Original Article

Serum Cortisol as a Useful Predictor of Cardiac Events in Patients with Chronic Heart Failure: the Impact of Oxidative Stress

Masayuki Yamaji; Takayoshi Tsutamoto¹; Chiho Kawahara; Keizo Nishiyama; Takashi Yamamoto; Masanori Fujii and Minoru Horie

Shiga University of Medical Science, Shiga, Japan

^* Corresponding author; email: tutamoto{at}belle.shiga-med.ac.jp

Background—The pathophysiological role of cortisol, which binds to the mineralocorticoid receptor with an affinity equal to that of aldosterone (ALD), may be influenced by oxidative stress in CHF patients. We evaluated cardiac event prediction using cortisol levels in chronic heart failure (CHF), comparison with ALD, adrenocorticotropic hormone (ACTH) and brain natriuretic peptide (BNP), and the impact of oxidative stress.

Methods and Results—We measured the plasma levels of biomarkers such as BNP, ALD, ACTH, serum cortisol and oxidized low density lipoprotein (oxLDL), a biomarker of oxidative stress, in 319 consecutive symptomatic CHF patients and then we prospectively followed these patients for a mean period of 33 months. During the follow-up period, 29 patients had cardiac events (death or hospitalization). Plasma levels of BNP, ALD, ACTH, oxLDL and serum cortisol (16.8±1.8 vs. 12.4±0.3µg/dL, p=0.01) were significantly higher in patients with cardiac events than in those without cardiac events. On stepwise multivariate analyses, high levels of BNP (p=0.0003), renin (p=0.002), cortisol (p=0.02) and oxLDL (p=0.002) were independent predictors of cardiac events, but ALD and ACTH levels were not. In patients with serum cortisol 12.5µg/dL, the hazard ratio of cardiac events in patients with oxLDL 12unit/mL was 5.0 compared with that in patients with oxLDL <12unit/mL (p=0.004).

Conclusions—These findings indicate that serum cortisol levels were a complementary and incremental cardiac event risk predictor in combination with BNP in CHF patient and that cardiac event prediction based on cortisol levels was influenced by oxidative stress.

Key Words: heart failure • natriuretic peptides • prognosis • cortisol • oxidative stress