Evidence of Stress in Hair Predicts AMI

Reed Miller

September 08, 2010

September 8, 2010 (London, Ontario) — A new study suggests the risk of MI triggered by stress may be evident in an individual's hair, indicating that chronic stress may be a significant contributing factor for acute MI similar to acute stress [1].

The association between psychosocial stress and cardiovascular disease is fairly well established in the literature, and acute stress is known to precipitate acute MI, according to Dr David Pereg (University of Western Ontario, London). But the role of chronic stress in the development of acute MI is less clear, because the assessment of past stress at the time of an MI is subject to significant recall bias--an acute event may cause a patient to try harder to recall previous stressors, and there are few reliable biological markers for the measurement of chronic stress.

Cortisol is a "stress hormone" that accumulates in hair and is secreted more during times of stress, so Pereg et al developed a method for longitudinal assessment of cortisol levels in hair prior to an acute event. Results of their 112-patient prospective case-control study of their method are published online September 2, 2010 in Stress.

The study included 56 male adults admitted to an intensive cardiac care unit with either ST-elevation or non-ST-elevation acute MI. The control group for the study consisted of 56 patients admitted to internal medicine wards for other indications. Pereg et al used an enzyme immunoassay technique to measure cortisol in the most proximal 3 cm of hair, because that represents the most recent three months of exposure. Median hair cortisol contents ranged from 295.3 ng/g in AMI patients to 224.9 ng/g in the controls (p=0.006). After the researchers controlled for other AMI risk factors such as age, LDL and HDL cholesterol, body mass, smoking status, and previous MI using multiple logistic regression, hair cortisol content remained the strongest predictor of acute MI (OR 17.4, 95% CI 2.15–140.5; p=0.007).

"The finding that hair cortisol content has emerged as the strongest predictor of acute MI should highlight the possibly tremendous role of chronic stress, which is often overlooked by physicians as a cardiovascular risk factor," the authors conclude. "This novel method may serve as a sensitive biomarker for changes in stress levels secondary to interventions." Measurement of hair cortisol may help to identify patients at high risk for future cardiovascular events who would benefit from an intensive assessment and treatment of the existing conventional cardiovascular risk factors.

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