Morning and afternoon serum cortisol level in patients with post-myocardial infarction depression

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Post-myocardial infarction depression (n=37). Intervention: Depression (BDI ≥ 10) vs. No depression (BDI < 10). Primary outcome: Difference between mean morning and evening plasma cortisol concentrations (p=0.0328).

Q: What does this research mean for the field?

Patients with post-myocardial infarction depression exhibit a significantly flattened diurnal serum cortisol profile compared to patients without depression. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Alina Wilkowska; Andrzej Rynkiewicz; Joanna Wdowczyk; Jerzy Landowski

doi:10.5603/cj.a2017.0123

October 24, 2017Cardiology JournalOpen Access

Morning and afternoon serum cortisol level in patients with post-myocardial infarction depression

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Key result

Post-myocardial infarction depression was associated with a significantly flattened diurnal serum cortisol profile compared to patients without depression.

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Why the study?

Does post-myocardial infarction depression alter the diurnal serum cortisol profile in patients with a first STEMI?

Key Points

To examine morning and afternoon serum cortisol concentrations and evaluate hypothalamic-pituitary-adrenal axis regulation in patients with depressive symptoms following a first myocardial infarction.
Enrolled 37 patients hospitalized due to a first myocardial infarction (MI).
Rated the severity of depressive symptoms using the Beck Depression Inventory (BDI), defining depression as a score of 10 or greater.
Collected morning and afternoon serum cortisol samples on the fifth day post-MI.
Depression (BDI ≥ 10) was present in 34.4% of post-MI patients.
A statistically significant difference between morning and evening concentrations was observed between depressed and non-depressed cohorts (F(1, 29) = 5.0405, p = 0.0328), reflecting a flattened diurnal cortisol curve.

Study Design

Type

Observational (n=37)

Multicenter

No

Structured PICO

Does post-myocardial infarction depression alter the diurnal serum cortisol profile in patients with a first STEMI?

P

Population

32 patients hospitalized due to a first myocardial infarction with ST elevation (STEMI), LVEF ≥ 40%, mean BMI 26.9 kg/m2. Exclusion criteria: endocrine diseases (diabetes, hypo- or hyperthyroidism), severe renal or hepatic failure, hormone therapy, active addiction to psychoactive substances, and psychiatric disorders other than depression.

I

Intervention

Presence of post-myocardial infarction depression (defined as Beck Depression Inventory score ≥ 10 on the fifth day after MI)

C

Comparator

Absence of post-myocardial infarction depression (Beck Depression Inventory score < 10)

O

Outcome

Morning and afternoon serum cortisol concentrations on the fifth day of the MIsurrogate

Main Result

p-value: p=0.0328

Patients with depressive symptoms directly after a first myocardial infarction exhibit a flattened diurnal serum cortisol profile, which may reflect HPA axis dysregulation.

Limitations

Small study group
Cortisol concentration was only tested on 1 day
Lack of a healthy control group
Small number of women in the study group and imbalance between groups
Small number of women in the study group (22%) and imbalance between the number of women in the depressed and non-depressed groups

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Implication

May signal HPA axis dysregulation in post-MI depression; hypothesis-generating for prognostic and interventional studies.

Abstract

BACKGROUND: Post-myocardial depression is a highly prevalent condition which worsens the course and prognosis of coronary artery disease. One possible pathogenetic factor is dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in cortisol profile disturbances. METHODS: Thirty seven patients hospitalized due to a first myocardial infarction (MI) were enrolled in this study. The Beck Depression Inventory (BDI) was used to rate the severity of their depressive symptoms. Morning and afternoon serum cortisol samples were taken on the fifth day of the MI. RESULTS: Depression, defined as BDI ≥ 10, was present in 34.4% of the patients. A statistically significant difference was observed between the mean morning and the evening plasma concentrations in patients with depression compared to the no-depression group: F (1.29) = 5.0405, p = 0.0328. CONCLUSIONS: Patients with depressive symptoms directly after MI have a flattened diurnal serum cortisol profile. This is particularly expressed in patients with longer lasting symptoms.

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Cite This Study

Wilkowska et al. (2017) conducted an observational in Post-myocardial infarction depression (n=37). Depression (BDI ≥ 10) vs. No depression (BDI < 10) was evaluated on Difference between mean morning and evening plasma cortisol concentrations (p=0.0328). Post-myocardial infarction depression was associated with a significantly flattened diurnal serum cortisol profile compared to patients without depression.

synapsesocial.com/papers/6a149e63283405f525df10e1 https://doi.org/10.5603/cj.a2017.0123

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Morning and afternoon serum cortisol level in patients with post-myocardial infarction depression

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Morning and afternoon serum cortisol level in patients with post-myocardial infarction depression

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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