The Journal of Clinical Endocrinology and Metabolism Journal Article

Long-Term Glucocorticoid Exposure and Incident Cardiovascular Diseases

October 08, 2024

The Lifelines Cohort

 

Eline S van der Valk, Mostafa Mohseni, Anand M Iyer, Maartje JB van den Hurk, Robin Lengton, Susanne Kuckuck, Vincent L Wester, Pieter JM Leenen, Willem A Dik, Jenny A Visser, Maryam Kavousi, Mina Mirzaian, Sjoerd AA van den Berg, Elisabeth FC van Rossum
The Journal of Clinical Endocrinology & Metabolism, Volume 109, Issue 10, October 2024, Pages 2520–2529
https://doi.org/10.1210/clinem/dgae081

Abstract

Context

Long-term glucocorticoid levels in scalp hair (HairGCs), including cortisol and the inactive form cortisone, represent the cumulative systemic exposure to glucocorticoids over months. HairGCs have repeatedly shown associations with cardiometabolic and immune parameters, but longitudinal data are lacking.

Design

We investigated 6341 hair samples of participants from the Lifelines cohort study for cortisol and cortisone levels and associated these to incident cardiovascular diseases (CVD) during 5 to 7 years of follow-up. We computed the odds ratio (OR) of HairGC levels for incident CVD via logistic regression, adjusting for classical cardiovascular risk factors, and performed a sensitivity analysis in subcohorts of participants < 60 years and ≥ 60 years of age. We also associated HairGC levels to immune parameters (total leukocytes and subtypes).

Results

Hair cortisone levels (available in n = 4701) were independently associated with incident CVD (P < .001), particularly in younger individuals (multivariate-adjusted OR 4.21, 95% CI 1.91–9.07 per point increase in 10-log cortisone concentration [pg/mg], P < .001). All immune parameters except eosinophils were associated with hair cortisone (all multivariate-adjusted P < .05).

Conclusion

In this large, prospective cohort study, we found that long-term cortisone levels, measured in scalp hair, represent a relevant and significant predictor for future CVD in younger individuals. These results highlight glucocorticoid action as possible treatment target for CVD prevention, where hair glucocorticoid measurements could help identify individuals that may benefit from such treatments.

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