TY - JOUR
T1 - Long-term glucocorticoids in relation to the metabolic syndrome and cardiovascular disease
T2 - A systematic review and meta-analysis
AU - Kuckuck, Susanne
AU - Lengton, Robin
AU - Boon, Mariëtte R.
AU - Boersma, Eric
AU - Penninx, Brenda W. J. H.
AU - Kavousi, Maryam
AU - van Rossum, Elisabeth F. C.
N1 - Funding Information: The authors wish to thank Wichor Bramer from the Erasmus MC Medical Library for developing the search strategies and to Priscilla Vlaming for statistical advice. We also wish to thank all the authors who provided us with additional information regarding their articles. In addition, we would like to thank Annelieke Roest and Layal Chaker for their conceptual advice regarding meta-analyses. Finally, we acknowledge that Fig. 1 was created with BioRender.com. Funding Information: This article was written as part of the research project “Stress in Action”: www.stress‐in‐action.com . Stress in Action is financially supported by the Dutch Research Council and the Dutch Ministry of Education, Culture and Science (NWO gravitation grant number 024.005.010). Publisher Copyright: © 2023 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.
PY - 2024/1
Y1 - 2024/1
N2 - The striking link of Cushing's syndrome with the metabolic syndrome (MetS) and cardiovascular disease (CVD) suggests that long-term exposure to extremely high cortisol levels catalyzes cardiometabolic deterioration. However, it remained unclear whether the findings from the extreme glucocorticoid overabundance observed in Cushing's syndrome could be translated into more subtle variations in long-term glucocorticoid levels among the general population, for example, due to chronic stress. Here, we performed a systematic review (PROSPERO: CRD42023425541) of evidence regarding the role of subtle variations in long-term biological stress, measured as levels of scalp hair cortisol (HairF) and cortisone (HairE), in the context of MetS and CVD in adults. We also performed a meta-analysis on the cross-sectional difference in HairF levels between individuals with versus without CVD. Seven studies were included regarding MetS, sixteen regarding CVD, and one regarding both. Most articles indicated a strong, consistent cross-sectional association of higher HairF and HairE levels with CVD, which was confirmed by our meta-analysis for HairF (eight studies, SMD = 0.48, 95% confidence intervals [CIs]: 0.16–0.79, p = 0.0095). Moreover, these relationships appear largely independent of standard risk factors. Age seems relevant as the effect seems stronger in younger individuals. Results regarding the associations of HairF and HairE with MetS were inconsistent. Altogether, long-term biological stress, measured as HairF and HairE, is associated with the presence of CVD, and less consistently with MetS. Prospective studies need to evaluate the directionality of this relationship and determine whether HairF and HairE can be used in addition to standard risk factors in predicting future cardiometabolic deterioration.
AB - The striking link of Cushing's syndrome with the metabolic syndrome (MetS) and cardiovascular disease (CVD) suggests that long-term exposure to extremely high cortisol levels catalyzes cardiometabolic deterioration. However, it remained unclear whether the findings from the extreme glucocorticoid overabundance observed in Cushing's syndrome could be translated into more subtle variations in long-term glucocorticoid levels among the general population, for example, due to chronic stress. Here, we performed a systematic review (PROSPERO: CRD42023425541) of evidence regarding the role of subtle variations in long-term biological stress, measured as levels of scalp hair cortisol (HairF) and cortisone (HairE), in the context of MetS and CVD in adults. We also performed a meta-analysis on the cross-sectional difference in HairF levels between individuals with versus without CVD. Seven studies were included regarding MetS, sixteen regarding CVD, and one regarding both. Most articles indicated a strong, consistent cross-sectional association of higher HairF and HairE levels with CVD, which was confirmed by our meta-analysis for HairF (eight studies, SMD = 0.48, 95% confidence intervals [CIs]: 0.16–0.79, p = 0.0095). Moreover, these relationships appear largely independent of standard risk factors. Age seems relevant as the effect seems stronger in younger individuals. Results regarding the associations of HairF and HairE with MetS were inconsistent. Altogether, long-term biological stress, measured as HairF and HairE, is associated with the presence of CVD, and less consistently with MetS. Prospective studies need to evaluate the directionality of this relationship and determine whether HairF and HairE can be used in addition to standard risk factors in predicting future cardiometabolic deterioration.
KW - HPA-axis
KW - cardiovascular disease
KW - cardiovascular risk factors
KW - hair glucocorticoids
KW - metabolic syndrome
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85176145586&origin=inward
UR - http://www.scopus.com/inward/record.url?scp=85176145586&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/joim.13739
DO - https://doi.org/10.1111/joim.13739
M3 - Review article
C2 - 37926862
SN - 0954-6820
VL - 295
SP - 2
EP - 19
JO - Journal of Internal Medicine
JF - Journal of Internal Medicine
IS - 1
ER -