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Cited by 343Stress Responses and CortisolAdrenal Hormones and DisordersCircadian rhythm and melatonin

The DOI matches its Crossref record; 32 of the 32 references it cites were found in a registry or an index.

Association of Diurnal Patterns in Salivary Cortisol with All-Cause and Cardiovascular Mortality: Findings from the Whitehall II Study

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Kumari, Meena, Shipley, Martin, Stafford, Mai, Kivimaki, Mika·2011·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2010-2137PMC PMC3085201
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Abstract

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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Metadata

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
DOI
10.1210/jc.2010-2137
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
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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