PMID- 26492313
OWN - NLM
STAT- MEDLINE
DCOM- 20161005
LR  - 20161230
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 203
DP  - 2016 Jan 15
TI  - High evening salivary cortisol is an independent predictor of increased mortality 
      risk in patients with systolic heart failure.
PG  - 69-73
LID - S0167-5273(15)30646-X [pii]
LID - 10.1016/j.ijcard.2015.10.084 [doi]
AB  - AIMS: Serum cortisol independently predicts mortality risk in patients with 
      systolic heart failure. Salivary cortisol may provide advantages as it better 
      reflects the biologically active free compound. Furthermore, sampling is 
      non-invasive and may easily be performed in outpatients. We comparatively 
      evaluated associations of morning (MSC) vs. evening salivary cortisol (ESC) and 
      all-cause mortality risk. METHODS AND RESULTS: MSC (8 am) and ESC (9 pm) were 
      determined in 229 patients with heart failure participating in the 
      Interdisciplinary Network for Heart Failure program (66 +/- 13 years; 21% female; 
      37% New York Heart Association (NYHA) class III/IV, median left ventricular 
      ejection fraction 33%). The association of cortisol with mortality risk was 
      determined by univariate and Cox multivariable regression analyses adjusting for 
      age, sex, NYHA class, and N-terminal pro-hormone B-type natriuretic peptide. 
      Compared to ESC, MSC was significantly higher and exhibited a higher variance: 
      median 0.59 ng/ml (interquartile range 0.41-0.93) vs. 0.25 ng/ml (0.15-0.48), 
      p<0.001. During 18 months of follow-up, 25 (11%) patients died. In univariate and 
      multivariable models mortality risk was not increased in the highest MSC 
      quartile: crude hazard ratio (HR) 1.81 (95% confidence interval 0.79-4.14, 
      p=0.160), adjusted HR 1.26 (0.51-3.13, p=0.616). However, patients in the highest 
      ESC quartile had a significantly increased mortality risk, suggesting that 
      associations of high ESC and increased mortality were independent of disease 
      severity: crude HR 3.33 (1.50-7.42, p=0.003), adjusted HR 2.49 (1.01-6.14, 
      p=0.047). ESC alone proved the best predictor of mortality. CONCLUSION: High ESC 
      but not MSC levels independently predict increased mortality risk in heart 
      failure.
CI  - Copyright (c) 2015 Elsevier Ireland Ltd. All rights reserved.
FAU - Hammer, Fabian
AU  - Hammer F
AD  - Comprehensive Heart Failure Center, University of Wurzburg, Wurzburg, Germany; 
      Department of Internal Medicine I, Cardiology, University Hospital Wurzburg, 
      Wurzburg, Germany; Department of Internal Medicine B, University Medicine 
      Greifswald, Greifswald, Germany. Electronic address: 
      fabian.hammer@uni-greifswald.de.
FAU - Deutschbein, Timo
AU  - Deutschbein T
AD  - Department of Internal Medicine I, Endocrine and Diabetes Unit, University 
      Hospital Wurzburg, Wurzburg, Germany.
FAU - Marx, Almuth
AU  - Marx A
AD  - Comprehensive Heart Failure Center, University of Wurzburg, Wurzburg, Germany.
FAU - Guder, Gulmisal
AU  - Guder G
AD  - Comprehensive Heart Failure Center, University of Wurzburg, Wurzburg, Germany; 
      Department of Internal Medicine I, Cardiology, University Hospital Wurzburg, 
      Wurzburg, Germany.
FAU - Michalski, Roman
AU  - Michalski R
AD  - Comprehensive Heart Failure Center, University of Wurzburg, Wurzburg, Germany; 
      Department of Internal Medicine I, Cardiology, University Hospital Wurzburg, 
      Wurzburg, Germany.
FAU - Ertl, Georg
AU  - Ertl G
AD  - Comprehensive Heart Failure Center, University of Wurzburg, Wurzburg, Germany; 
      Department of Internal Medicine I, Cardiology, University Hospital Wurzburg, 
      Wurzburg, Germany.
FAU - Allolio, Bruno
AU  - Allolio B
AD  - Comprehensive Heart Failure Center, University of Wurzburg, Wurzburg, Germany; 
      Department of Internal Medicine I, Endocrine and Diabetes Unit, University 
      Hospital Wurzburg, Wurzburg, Germany.
FAU - Angermann, Christiane E
AU  - Angermann CE
AD  - Comprehensive Heart Failure Center, University of Wurzburg, Wurzburg, Germany; 
      Department of Internal Medicine I, Cardiology, University Hospital Wurzburg, 
      Wurzburg, Germany.
FAU - Stork, Stefan
AU  - Stork S
AD  - Comprehensive Heart Failure Center, University of Wurzburg, Wurzburg, Germany; 
      Department of Internal Medicine I, Cardiology, University Hospital Wurzburg, 
      Wurzburg, Germany.
FAU - Fassnacht, Martin
AU  - Fassnacht M
AD  - Comprehensive Heart Failure Center, University of Wurzburg, Wurzburg, Germany; 
      Department of Internal Medicine I, Endocrine and Diabetes Unit, University 
      Hospital Wurzburg, Wurzburg, Germany; Central Laboratory, Research Unit, 
      University Hospital Wurzburg, Wurzburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20151020
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - WI4X0X7BPJ (Hydrocortisone)
SB  - IM
MH  - Cross-Sectional Studies
MH  - Female
MH  - Heart Failure, Systolic/metabolism/*mortality
MH  - Humans
MH  - Hydrocortisone/*analysis/metabolism
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Risk Assessment
MH  - Saliva/*chemistry
MH  - Time Factors
OTO - NOTNLM
OT  - Cortisol
OT  - Glucocorticoids
OT  - Mortality
OT  - Saliva
OT  - Survival
OT  - Systolic heart failure
EDAT- 2015/10/23 06:00
MHDA- 2016/10/07 06:00
CRDT- 2015/10/23 06:00
PHST- 2015/07/01 00:00 [received]
PHST- 2015/09/22 00:00 [revised]
PHST- 2015/10/12 00:00 [accepted]
PHST- 2015/10/23 06:00 [entrez]
PHST- 2015/10/23 06:00 [pubmed]
PHST- 2016/10/07 06:00 [medline]
AID - S0167-5273(15)30646-X [pii]
AID - 10.1016/j.ijcard.2015.10.084 [doi]
PST - ppublish
SO  - Int J Cardiol. 2016 Jan 15;203:69-73. doi: 10.1016/j.ijcard.2015.10.084. Epub 
      2015 Oct 20.