Depression is associated with flatter cortisol rhythms in patients with coronary artery disease
Abstract
Objective Depression is associated with coronary heart disease, but the underlying mechanisms are not fully understood. Cortisol is involved in the development of coronary artery disease (CAD), but evidence directly linking depression with cortisol in patients with CAD is limited. This study evaluated cortisol output over the day in patients with suspected CAD in relation to depressive symptoms.Methods Eighty-eight patients who were being investigated for suspected CAD (defined by clinical symptoms plus positive exercise tests or myocardial perfusion scans) took eight saliva samples over the day and evening. Depressed mood was assessed with the Beck Depression Inventory. Actigraphy was used to define time of waking objectively.Results The cortisol awakening response and cortisol rhythm over the remainder of the day and evening were analyzed separately. Fifty-two (61.9%) patients were later found to have definite CAD on angiography, while the remainder did not. The cortisol slope over the day was flatter in more depressed patients with CAD (P<.001) but was not related to depression in patients without CAD (P=.68). This effect was due to the combination of lower cortisol early in the day and higher cortisol in the evening in more depressed CAD patients, independent of age, gender, medication, and times of waking and sleeping (P=.003). Additionally, cortisol measured on waking and 15 and 30 min after waking was greater in CAD than in non-CAD patients (P=.04), but was not related to depression.Conclusions The flatter cortisol rhythms of more depressed CAD patients may contribute to the progression of coronary atherosclerosis.
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When both CARi and AUCw were measured, their associations with psychosocial functioning measures differed.
“In studies in which both CARi and AUCw were measured, their relationships to measures of psychosocial functioning were not the same (e.g., Bhattacharyya et al., 2008; Chida & Steptoe, 2009; Ellenbogen et al., 2006; Mommersteeg et al., 2006; Sonnenschein et al., 2007; Whitehead et al., 2007)”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Bhattacharyya et al., 2008
Cites
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988) · Clinical Psychology Review · doi:10.1016/0272-7358(88)90050-5 · Cited by 11,696 · see citing works
Nicholson, A., Kuper, H., & Hemingway, H. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehl338 · Cited by 1,353 · see citing works
Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival
Sephton, S. E. (2000) · Journal of the National Cancer Institute · doi:10.1093/jnci/92.12.994 · Cited by 1,082 · see citing works
Clinical and Biochemical Manifestations of Depression
Gold, P. W., Goodwin, F. K., & Chrousos, G. P. (1988) · New England Journal of Medicine · doi:10.1056/nejm198808183190706 · Cited by 1,057 · see citing works
Depression as a Risk Factor for Coronary Artery Disease: Evidence, Mechanisms, and Treatment
Lett, H. S., Blumenthal, J. A., Babyak, M. A., Sherwood, A., Strauman, T., Robins, C., & Newman, M. F. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000126207.43307.c0 · Cited by 849 · see citing works
Day-to-day dynamics of experience–cortisol associations in a population-based sample of older adults
Adam, E. K., Hawkley, L. C., Kudielka, B. M., & Cacioppo, J. T. (2006) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0605053103 · Cited by 782 · see citing works
Lespérance, F., Frasure‐Smith, N., Talajic, M. R., & Bourassa, M. G. (2002) · Circulation · doi:10.1161/hc0902.104707 · Cited by 722 · see citing works
PSYCHONEUROENDOCRINOLOGY OF DEPRESSION
Plotsky, P. M., Owens, M. J., & Nemeroff, C. B. (1998) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(05)70006-x · Cited by 672 · see citing works
Genetic factors, perceived chronic stress, and the free cortisol response to awakening
Wüst, S., Federenko, I. S., Hellhammer, D. H., & Kirschbaum, C. (2000) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(00)00021-4 · Cited by 642 · see citing works
Objectively Measured Sleep Characteristics among Early-Middle-Aged Adults
Lauderdale, D. S., Knutson, K. L., Yan, L. L., Rathouz, P. J., Hulley, S. B., Sidney, S., & Liu, K. (2006) · American Journal of Epidemiology · doi:10.1093/aje/kwj199 · Cited by 581 · see citing works
Stress, hypercortisolism and corticosteroid receptors in depression: implicatons for therapy
Holsboer, F. (2001) · Journal of Affective Disorders · doi:10.1016/s0165-0327(00)00352-9 · Cited by 575 · see citing works
Wong, M., Kling, M. A., Munson, P. J., Listwak, S. J., Licinio, J., Prolo, P., Karp, B., McCutcheon, I. E., Geracioti, T. D., DeBellis, M. D., et al. (2000) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.97.1.325 · Cited by 575 · see citing works
Clinical and Biochemical Manifestations of Depression
Gold, P. W., Goodwin, F. K., & Chrousos, G. P. (1988) · New England Journal of Medicine · doi:10.1056/nejm198808113190606 · Cited by 547 · see citing works
Hellhammer, J., Fries, E., Schweisthal, O. W., Schlotz, W., Stone, A. A., & Hagemann, D. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.10.005 · Cited by 540 · see citing works
Fink, G. (2000) · Cited by 502 · see citing works
Actigraphy Validation with Insomnia
Lichstein, K. L., Stone, K. C., James Donaldson, R., Nau, S. D., Soeffing, J. P., Murray, D. M., Lester, K. W., & Aguillard, R. N. (2006) · SLEEP · doi:10.1093/sleep/29.2.232 · Cited by 502 · see citing works
Souverein, P. C., Bérard, A., van Staa, T. P., Cooper, C. C., Egberts, T. C. G., Leufkens, H. G. M., & Walker, B. (2004) · Heart · doi:10.1136/hrt.2003.020180 · Cited by 478 · see citing works
Goodyer, I. M., Herbert, J., Tamplin, A., & Altham, P. M. E. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.177.6.499 · Cited by 436 · see citing works
Schmidt-Reinwald, A., Pruessner, J. C., Hellhammer, D. H., Federenko, I., Rohleder, N., Schürmeyer, T. H., & Kirschbaum, C. (1999) · Life Sciences · doi:10.1016/s0024-3205(99)00103-4 · Cited by 367 · see citing works
Cortisol, Testosterone, and Coronary Heart Disease: Prospective Evidence From the Caerphilly Study
Smith, G., Ben-Shlomo, Y., Beswick, A., Yarnell, J., Lightman, S., & Elwood, P. (2005) · Circulation · doi:10.1161/circulationaha.104.489088 · Cited by 348 · see citing works
Diurnal mood variation in major depressive disorder
Peeters, F., Berkhof, J., Delespaul, P., Rottenberg, J., & Nicolson, N. A. (2006) · Emotion · doi:10.1037/1528-3542.6.3.383 · Cited by 306 · see citing works
Adam, E. K. (2001) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(00)00045-7 · Cited by 300 · see citing works
Güder, G., Bauersachs, J. K., Frantz, S., Weismann, D., Allolio, B., Ertl, G., Angermann, C. E., & Störk, S. (2007) · Circulation · doi:10.1161/circulationaha.106.653964 · Cited by 294 · see citing works
Flattened cortisol rhythms in metastatic breast cancer patients
Abercrombie, H. C., Giese‐Davis, J., Sephton, S. E., Epel, E. S., Turner‐Cobb, J. M., & Spiegel, D. (2004) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2003.11.003 · Cited by 287 · see citing works
Vaccarino, V., Johnson, B. D., Sheps, D. S., Reís, S. E., Kelsey, S. F., Bittner, V., Rutledge, T., Shaw, L. J., Sopko, G. S., & Merz, C. N. B. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.07.069 · Cited by 263 · see citing works
Diurnal cortisol decline is related to coronary calcification: CARDIA study
Matthews, K., Schwartz, J., Cohen, S., & Seeman, T. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000244071.42939.0e · Cited by 240 · see citing works
Morning cortisol as a risk factor for subsequent major depressive disorder in adult women
Harris, T. O., Borsanyi, S., Messari, S., Stanford, K., Cleary, S. E., Shiers, H. M., Brown, G. W., & Herbert, J. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.177.6.505 · Cited by 220 · see citing works
Subjective socioeconomic position, gender and cortisol responses to waking in an elderly population
Wright, C. E., & Steptoe, A. (2005) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.01.007 · Cited by 218 · see citing works
Self-citationDoes altered glucocorticoid homeostasis increase cardiovascular risk?
GIROD, J., & BROTMAN, D. (2004) · Cardiovascular Research · doi:10.1016/j.cardiores.2004.07.006 · Cited by 193 · see citing works
Increase in Concentration of Waking Salivary Cortisol in Recovered Patients With Depression
Bhagwagar, Z., Hafizi, S., & Cowen, P. J. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.10.1890 · Cited by 161 · see citing works
Effect of Depression on Five-Year Mortality After an Acute Coronary Syndrome
Grace, S. L., Abbey, S. E., Kapral, M. K., Fang, J., Nolan, R. P., & Stewart, D. E. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2005.06.052 · Cited by 161 · see citing works
Cortisol awakening response is elevated in acute coronary syndrome patients with type-D personality
Whitehead, D. L., Perkins-Porras, L., Strike, P. C., Magid, K. S., & Steptoe, A. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.11.005 · Cited by 159 · see citing works
Self-citationDockray, S., Bhattacharyya, M. R., Molloy, G. J., & Steptoe, A. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.10.001 · Cited by 157 · see citing works
Self-citationDavidson, K. W., Kupfer, D. J., Bigger, J. T., Califf, R. M., Carney, R. M., Coyne, J. C., Czajkowski, S. M., Frank, E., Frasure‐Smith, N., Freedland, K. E., et al. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000233233.48738.22 · Cited by 154 · see citing works
The diagnoses of patients admitted with acute chest pain but without myocardial infarction
Fruergaard, P., Launbjerg, J., Hesse, B., et al. (1996) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a014998 · Cited by 150 · see citing works
Broadley, A., Korszun, A., Abdelaal, E., Moskvina, V., Jones, C. J. H., Nash, G. B., Ray, C. J., Deanfield, J. E., & Frenneaux, M. P. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.03.068 · Cited by 148 · see citing works
Otte, C., Marmar, C. R., Pipkin, S. S., Moos, R. H., Browner, W. S., & Whooley, M. A. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.06.003 · Cited by 124 · see citing works
Spiegel, D., Giese‐Davis, J., Taylor, C. B., & KRAEMER, H. C. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.09.004 · Cited by 99 · see citing works
Aardal-Eriksson, E., Eriksson, T. E., & Thorell, L. (2001) · Biological Psychiatry · doi:10.1016/s0006-3223(01)01253-7 · Cited by 93 · see citing works
Increased Diurnal Plasma Concentrations of Cortisone in Depressed Patients
Weber, B., Lewicka, S., Deuschle, M., Colla, M., Vecsei, P., & Heuser, I. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.3.6469 · Cited by 92 · see citing works
Taylor, C. B., Conrad, A., Wilhelm, F. H., Neri, E., DeLorenzo, A., Kramer, M. A., Giese‐Davis, J., Roth, W. T., Oka, R. K., Cooke, J. P., et al. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000222372.16274.92 · Cited by 91 · see citing works
Koertge, J., Al-Khalili, F., Ahnve, S., Janszky, I., Svane, B., & Schenck-Gustafsson, K. G. (2002) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(02)00002-1 · Cited by 70 · see citing works
Marital-role quality and stress-related psychobiological indicators
BARNETT, R. C., Steptoe, A., & Gareis, K. C. (2005) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm3001_5 · Cited by 66 · see citing works
Self-citationSteptoe, A., & Serwinski, B. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-800951-2.00034-0 · Cited by 65 · see citing works
Self-citationBass, C., & Mayou, R. (2002) · BMJ · doi:10.1136/bmj.325.7364.588 · Cited by 61 · see citing works
Tenerz, Å., Nilsson, G., Forberg, R., Öhrvik, J., Malmberg, K., Berne, C., & Leppert, J. (2003) · Journal of Internal Medicine · doi:10.1046/j.1365-2796.2003.01221.x · Cited by 55 · see citing works
von Känel, R., Mausbach, B. T., Kudielka, B. M., & Orth‐Gomér, K. (2007) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-007-0035-7 · Cited by 33 · see citing works
Decreased impact of post-myocardial infarction depression on cardiac prognosis?
Spijkerman, T. A., van den Brink, R. H. S., May, J. F., Winter, J. B., van Melle, J. P., de Jonge, P., Crijns, H. J. G. M., & Ormel, J. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.02.016 · Cited by 29 · see citing works
Cortisol level predicts myocardial infarction in patients with ischaemic chest pain
Bain, R. J. I., Poeppinghaus, V. J. I., Jones, G. M., et al. (1989) · International Journal of Cardiology · doi:10.1016/0167-5273(89)90164-2 · Cited by 21 · see citing works
Madjirova, N., Tashev, T., Delchev, N. K., & Bakalova, R. G. (1995) · International Journal of Psychophysiology · doi:10.1016/0167-8760(95)00027-5 · Cited by 12 · see citing works
STEPTOE, A. (2007) · Elsevier eBooks · doi:10.1016/b978-012373947-6/00451-7 · Cited by 11 · see citing works
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Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis
Chida, Y., & Steptoe, A. (2009) · Biological Psychology · doi:10.1016/j.biopsycho.2008.10.004 · Cited by 1,032 · see citing works
Self-citationAdam, E. K., Quinn, M. E., Tavernier, R., McQuillan, M. T., Dahlke, K. A., & Gilbert, K. E. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.05.018 · Cited by 905 · see citing works
Epidemiology and treatment of depression in patients with chronic medical illness
J. Katon, W. (2011) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2011.13.1/wkaton · Cited by 820 · see citing works
Nikkheslat, N., Zunszain, P. A., Horowitz, M. A., Barbosa, I. G., Parker, J. A., Myint, A.-M., Schwarz, M. J., Tylee, A. T., Carvalho, L. A., & Pariante, C. M. (2015) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2015.02.002 · Cited by 147 · see citing works
Boggero, I. A., Hostinar, C. E., Haak, E. A., Murphy, M. L. M., & Segerstrom, S. C. (2017) · Biological Psychology · doi:10.1016/j.biopsycho.2017.08.058 · Cited by 97 · see citing works
“, Bhattacharyya et al., 2008; Chida & Steptoe, 2009; Ellenbogen et al., 2006; Mommersteeg et al., 2006; Sonnenschein et al., 2007; Whitehead et al., 2007), suggesting possible measure-dependent effects. Yet another source of heterogeneity in the literature emerges from specific subytpes of psychosocial predictors havi…”
BackgroundDiurnal cortisol rhythm and cognitive functioning in toddlers: the Generation R Study
Saridjan, N. S., Henrichs, J., Schenk, J. J., Jaddoe, V. W. V., Hofman, A., Kirschbaum, C., Verhulst, F. C., & Tiemeier, H. (2014) · Child Neuropsychology · doi:10.1080/09297049.2013.763921 · Cited by 24 · see citing works
- Authors
- Bhattacharyya, M. R., Molloy, G. J., & Steptoe, A.
- Affiliations
- University College London (GB)
- Corresponding author
- Bhattacharyya, Mimi R.
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2008-08
- Volume
- 65
- Issue
- 2
- Pages
- 107-113
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2011883695
- Cited by
- 103
- References
- 51
- Citations by year
- 2026: 2 · 2025: 3 · 2023: 7 · 2022: 4 · 2021: 1 · 2020: 8 · 2019: 8 · 2018: 6 · 2017: 7 · 2016: 8 · 2015: 7 · 2014: 6 · 2013: 4 · 2012: 11
- FWCI
- 3.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- British Heart Foundation
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- depression, coronary artery disease, cortisol, diurnal cortisol rhythm, cortisol awakening response, depressive symptoms, salivary cortisol, actigraphy, circadian rhythm
- MeSH terms
- Aged, Circadian Rhythm, Coronary Artery Disease, Depressive Disorder, Female, Humans, Hydrocortisone, Male, Middle Aged, Personality Inventory, Prognosis, Risk Factors, Saliva, Coronary Angiography, Disease Progression
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