What does this research mean for the field?

Higher hair cortisol concentration (HCC) correlates with increased serum IL-6 levels and worse clinical presentation in patients with acute coronary syndrome (ACS). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To explore the relationship between chronic psychosocial stress and acute destabilization of cardiovascular disease via inflammation markers.

February 8, 2026

The role of chronic psycho-social stress and its link with inflammation in atherosclerotic cardiovascular disease destabilization: the STRESS MI ACTION STUDY

Key Result

Hair cortisol concentration was significantly higher in acute coronary syndrome patients (3.91 pg/mg) than in chronic coronary syndrome (2.89) or CV risk factor-only groups (0.45) and correlated with

Key Points

To explore the relationship between chronic psychosocial stress and acute destabilization of cardiovascular disease via inflammation markers.
Multicenter observational case-control study with 280 patients.
Assessment of hair cortisol concentration (HCC) as a stress biomarker.
Measurement of interleukin-6 (IL-6) serum concentration using ELISA.
Correlation analysis between HCC and IL-6 was analyzed.
HCC levels increased significantly with disease severity from CRF to CCS to ACS (p < 0.01).
There was a positive correlation between HCC and serum IL-6 (Spearman Rho= 0.40, p=0.001).
Mean HCC was highest in ACS patients (3.91 pg/mg) compared to CCS (2.89 pg/mg) and CRF (0.45 pg/mg).

Structured PICO

Does hair cortisol concentration (HCC) correlate with the clinical severity of atherosclerotic cardiovascular disease and systemic inflammation (IL-6)?

Population

280 subjects with different clinical severity: 140 with acute coronary syndrome (ACS) (70 with and 70 without ST-elevation myocardial infarction), 70 with chronic coronary syndrome (CCS), and 70 with traditional CV risk factors only (CRF).

Intervention

Hair cortisol concentration (HCC) measurement

Comparator

Comparison across ACS, CCS, and CRF groups

Outcome

Hair cortisol concentration (HCC) across clinical severity groups and its correlation with serum interleukin (IL)-6surrogate

Hair cortisol concentration, a biomarker of chronic stress, is significantly elevated in patients with acute coronary syndromes and correlates with systemic inflammation (IL-6).

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background . A growing body of evidences identify chronic psychosocial stress as a new cardiovascular (CV) risk factor and the current guidelines recommend its assessment and treatment. However, methods for accurate chronic stress assessment are lacking, as well as the precise characterization of mechanisms linking stress with CV atherosclerotic disease acute destabilization. Purpose To quantify stress, using hair cortisol concentration (HCC), an emerging biomarker of chronic stress, in a real-word cohort of patients, presenting with different clinical severity: acute coronary syndrome (ACS), chronic coronary syndrome (CCS) or traditional CV risk factors only (CRF). To investigate whether HCC correlates with inflammation primarily assessed by interleukin (IL)-6 serum concentration. Methods Among patients enrolled into the STRESS-MI-ACTION, a multicenter observational case-control study, hair samples to assess HCC were collected from the posterior scalp. HCC was analyzed by a centralized laboratory using a high-performance liquid chromatography-mass spectrometer. IL-6 was measured by an automated ELISA workflow. A correlation analysis was performed to assess relationship between HCC and IL-6. Results A total of 280 subject were included in the study: 140 with ACS (70 with and 70 without ST-elevation myocardial infarction, 70 with CCS and 70 with CRF). The mean HCC (Q1-Q3) was 3.91 (2.99-5.86) pg/mg in the ACS group, 2.89 (2.30-2.46) pg/mg in the CCS group, 0.45 (0.30-0.76) pg/mg in the CRF group. After adjusting for age, sex, and traditional CV risk factors, HCC was progressively increased with the worsening of the clinical presentation (p for trend 0.01 across the three groups, Fig. 1). A positive significant correlation was found between HCC and serum IL-6 (Spearman Rho= 0.40, p=0.001, Fig. 2). Conclusion HCC, expression of chronic stress in the previous months, is associated with acute CV disease destabilization due to ACS, possibly mediated by inflammation as suggested by the linear correlation between HCC and IL-6 serum levels. Quantitative stress measurement may be helpful in tailoring CV preventive strategies.

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