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International Journal of Behavioral Medicine

Published in:

01-09-2013

Anxiety as Predictor of the Cortisol Awakening Response in Patients with Coronary Heart Disease

Authors: Melanie Merswolken, Hans-Christian Deter, Sabine Siebenhuener, Kristina Orth-Gomér, Cora Stefanie Weber

Published in: International Journal of Behavioral Medicine | Issue 3/2013

Abstract

Background

Anxiety is associated with worse outcomes in patients with coronary heart disease (CHD). A dysregulation of the HPA axis is a potential mechanism linking psychological factors and coronary disease. No study has yet investigated the relationship between anxiety and cortisol among patients with established CHD.

Purpose

The aim of this study was to assess the association between anxiety and the cortisol awakening response in patients with CHD.

Method

Four salivary cortisol samples were used to assess two measures of the cortisol awakening response (CAR) in 47 patients with established CHD. Anxiety was measured using the Hospital Anxiety and Depression Scale (HADS).

Results

Higher anxiety values were associated with a higher total output of cortisol in the first hour after awakening (AUCg, area under the curve with respect to ground) (p = 0.04) and a nonsignificant trend towards a more pronounced increase (AUCi, area under the curve with respect to increase) (p = 0.08). In patients who had a history of myocardial infarction (MI), the cortisol output was lower compared to patients who had no previous MI (p = 0.02). In linear regression analyses, anxiety emerged as significant predictor of AUCg and AUCi after controlling for MI, ejection fraction (LVEF, left ventricular ejection fraction), and depression.

Conclusions

Our results provide further indications for an association between anxiety and a dysregulation of the HPA axis. History of MI emerged as second predictor of cortisol output in the morning.

The correlation between AUCi and CAR values (computed by subtracting the baseline cortisol values from the values at +30 min) was r = 0.94, p = 0.000.

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Title: Anxiety as Predictor of the Cortisol Awakening Response in Patients with Coronary Heart Disease
Authors: Melanie Merswolken
Hans-Christian Deter
Sabine Siebenhuener
Kristina Orth-Gomér
Cora Stefanie Weber
Publication date: 01-09-2013
Publisher: Springer US
Published in: International Journal of Behavioral Medicine / Issue 3/2013
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI: https://doi.org/10.1007/s12529-012-9233-6

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Springer Medicine

Anxiety as Predictor of the Cortisol Awakening Response in Patients with Coronary Heart Disease

Abstract

Background

Purpose

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Method

Results

Conclusions

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