Association of Diurnal Patterns in Salivary Cortisol with All-Cause and Cardiovascular Mortality: Findings from the Whitehall II Study
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Context: Evidence for the association of cortisol with mortality or disease events is mixed, possibly due to a failure to consider diurnal cortisol patterns. Objective: Our objective was to examine the association of diurnal cortisol patterns throughout the day with cardiovascular and noncardiovascular mortality in a community-dwelling population. Design: This was a prospective cohort study among 4047 civil servants, the Whitehall II study, United Kingdom. We measured diurnal cortisol patterns in 2002–2004 from six saliva samples obtained over the course of a normal weekday: at waking, +30 min, +2.5 h, +8 h, +12 h, and bedtime. Participants were subsequently followed for all-cause and cause-specific mortality until January 2010. Participants: Participants included 4047 men and women aged 61 yr on average at baseline. Outcomes: We assessed all-cause, cardiovascular, and noncardiovascular death. Results: There were 139 deaths, 32 of which were deaths due to cardiovascular disease, during a mean follow-up period of 6.1 yr. Flatter slopes in cortisol decline across the day were associated with increased risk of all-cause mortality (hazard ratio for 1 sd reduction in slope steepness 1.30; 95% confidence interval (CI) = 1.09–1.55). This excess mortality risk was mainly driven by an increased risk of cardiovascular deaths (hazard ratio = 1.87; 95% confidence interval = 1.32–2.64). The association with cardiovascular deaths was independent of a wide range of covariates measured at the time of cortisol assessment. There was no association between morning cortisol, the cortisol awakening response, and mortality outcomes. Conclusions: These findings demonstrate, for the first time, the relationship between a flatter slope in cortisol levels across the day and an increased risk of cardiovascular disease mortality in a nonclinical population.
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Elevated levels of cortisol in the evening are associated with increased mortality risk from cardiovascular disease.
“Elevated levels of cortisol in the evening are associated with increased mortality risk from cardiovascular disease 32.”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [32]
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Self-citationExposure to police-related deaths and physiological stress among urban black youth
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- Authors
- Kumari, M., Shipley, M., Stafford, M., & Kivimaki, M.
- Affiliations
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom
- University College London (GB)
- ORCID
- Stafford, Mai
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2011-05-01
- Volume
- 96
- Issue
- 5
- Pages
- 1478-1485
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3085201
- OpenAlex
- W2059693239
- Cited by
- 343
- References
- 32
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 8 · 2023: 20 · 2022: 18 · 2021: 17 · 2020: 31 · 2019: 25 · 2018: 28 · 2017: 33 · 2016: 48 · 2015: 25 · 2014: 26 · 2013: 21 · 2012: 23
- FWCI
- 9.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- British Heart Foundation (HS06516, RG/07/008/23674)
- University College London
- European Commission
- Health and Safety Executive
- Academy of Finland
- National Institutes of Health (-0001)
- Agency for Healthcare Research and Quality (HS06516)
- Medical Research Council (HS06516, WC1E 6BT)
- Economic and Social Research Council (RES 596-28-0001)
- National Institute on Aging (AG 13196, R37AG013196, R01AG013196)
- National Heart, Lung, and Blood Institute (HS06516, HL36310, R01HL036310)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- salivary cortisol, cardiovascular mortality, all-cause mortality, cortisol awakening response, morning cortisol, circadian rhythm, public sector employees, Whitehall II study
- MeSH terms
- Age Factors, Aged, Cardiovascular Diseases, Circadian Rhythm, Female, Follow-Up Studies, United Kingdom, Humans, Hydrocortisone, Male, Middle Aged, Mortality, Prospective Studies, Risk Factors, Saliva, Sex Factors, Socioeconomic Factors, Stress, Psychological, Cohort Studies, Health Behavior
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