Elevated Levels of Cortisol in Hair Precede Acute Myocardial Infarction

Background: Prolonged stress is a factor that negatively affects public health and disease risks in our society today. A general perception is that stress is a risk factor for cardiovascular diseases, but the scientific evidence for this is scarce. This study aims to investigate whether middle-aged men and women who had suffered an acute myocardial infarction (AMI) had elevated cortisol concentration measured in their hair (HCC), during the month before the acute event, compared to a large control group from the general population. Methods: A case-control study on a regional population-based cohort from southeastern Sweden. Cases of acute myocardial infarction N=174 (average age 58 years, SD = 6) were recruited from cardiology clinics and the controls N = 3156 (average 57 years, SD = 4) from the general population from the Swedish CArdioPulmonary bioImage Study (SCAPIS). Findings: The median HCC for men who had suffered an AMI was 57.8 pg/mg (IQR 29.0-167.6), compared to 25.9 (17.0-52.0) pg/mg for the control group (p < 0.0001). The median HCC for women who had suffered an AMI was 46.6 (IQR 20.5-100.8) pg/mg, and 20.1 (IQR 13.6-38.2) pg/mg in the control group (p < 0.0001). The discrimination of cases with AMI from controls remained statistically significant after controlling for other potential cardiovascular risk factors in both men and women. Interpretation: Middle-aged men and women with acute myocardial infarction had significantly elevated cortisol levels during the month before the cardiac event. The biomarker hair cortisol concentration was independently and significantly related to AMI, even after traditional cardiovascular risk factors was taken into account. Chronic stress may be a new and a clinically significant risk factor for AMI. Funding Statement: This work was supported by a research grant from the Swedish AFA Insurance, Stockholm by [Grant number Dnr: 160340]. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Data collection of the AMI cases was approved by the Regional Ethical Review Board in Linkoping (# 2016-79-31, #2016-453-32, #2017-106-32). The SCAPIS study was approved by the Umea Ethical Review Board (# 2010-228-31 M). All participants gave their written informed consent to participate and the study complies with the Declaration of Helsinki.