Relationships between cortisol level, mortality and chronic diseases in older persons

CONTEXT: High cortisol level is known to be associated with osteoporosis, hypertension, diabetes mellitus (DM), susceptibility to infections and depression and may protect against chronic obstructive pulmonary disease. OBJECTIVE: This study assesses the association between cortisol level, 6- to 7.5-year mortality risk and prevalence of chronic diseases. DESIGN/SETTING/PARTICIPANTS: Subjects were selected from the Longitudinal Aging Study Amsterdam, an ongoing multidisciplinary cohort study in a general population of older persons (>/=65 years). Serum cortisol was measured in 1181 men and women in 1995/1996 (second cycle) and salivary cortisol in 998 men and women in 2001/2002 (fourth cycle). MAIN OUTCOME MEASURES: Six to seven and a half year mortality and prevalence of chronic diseases. RESULTS: Men with high salivary morning cortisol had a higher mortality risk than men with low levels hazard ratio (HR) = 1.63, P = 0.04 for the third vs. the lowest tertile. Women with high salivary evening cortisol had a higher mortality risk than women with low levels (HR = 1.82, P = 0.04 for the third vs. the lowest tertile). In men, high serum cortisol was independently associated with chronic nonspecific lung disease (CNSLD): odds ratio (OR) = 0.72, P < 0.01; hypertension: OR = 1.38, P < 0.01; DM: OR = 1.38, P = 0.02. In women, high salivary evening cortisol was independently associated with DM: OR = 1.33, P = 0.01 and CNSLD: OR = 0.58, P = 0.02. No independent association between cortisol and number of chronic diseases was found. CONCLUSION: High salivary cortisol levels are associated with increased mortality risk in a general older population. High cortisol levels are associated with higher risks of hypertension and DM and lower risk of CNSLD.