Increased Cortisol Level: A Possible Link Between Climacteric Symptoms and Cardiovascular Risk Factors

Angelo Cagnacci, MD, PhD; Marianna Cannoletta, MD; Simona Caretto, MD; Renata Zanin, MD; Anjeza Xholli, MD; Annibale Volpe, MD

Disclosures

Menopause. 2011;18(3):273-278. 

In This Article

Results

The characteristics of the 85 enrolled women are reported in Table 1 and Table 2.

Values of 24-hour urinary cortisol were not related to age, age at menopause, and months since menopause. By contrast, 24-hour urinary cortisol level was related to the scores on the Greene Climacteric Scale, STAI, and Zung scale (Table 3). Furthermore, the 24-hour urinary cortisol level was related to scores on the Greene Climacteric Scale subscale for vasomotor symptoms, anxiety, depression, somatic symptoms, and sexuality (Table 3). The 24-hour urinary cortisol level was related also to the woman's weight, BMI, and waist circumference (Table 3).

After correction for collinearity, only BMI and scores on the Greene Climacteric Scale, the Greene Climacteric Scale subscale for vasomotor symptoms, the Greene Climacteric Scale subscale for sexuality, and the Zung scale were used in further analyses. Values of 24-hour urinary cortisol, stratified by quartiles of BMI, scores on the Greene Climacteric Scale, scores on the Greene Climacteric Scale subscale for vasomotor symptoms and sexuality, and scores on the Zung scale are reported in Figure 1. All these factors were entered into the stepwise regression analysis. The Greene Climacteric Scale explained 32.5% and BMI explained 10.3% of the variance of 24-hour urinary cortisol level. Vice versa, scores on the Greene Climacteric Scale subscales for vasomotor symptoms and sexuality or the Zung scale failed to be independent determinants of 24-hour urinary cortisol level. The linear model for 24-hour urinary cortisol level (r = 0.428, P = 0.0003) was determined by the Greene Climacteric Scale total score (CR, 1.343; 95% CI, 0.441–2.246) and BMI (CR, 4.47; 95% CI, 1.26–7.68; Fig. 2).

Figure 1.

Mean ± SD 24-hour urinary cortisol level stratified for quartiles of BMI, severity of hot flushes derived by the appropriate Greene Climacteric Scale subscale, Greene Climacteric Scale for climacteric symptoms, severity of sexual symptoms, derived by the respective subscaleof the Greene Climacteric Scale, or Zung scale score for depressive symptoms. *P < 0.05 vs moderate, P < 0.001 vs slight, P < 0.02 vs none, by one-factor ANOVA. § P < 0.05 vs slight, P < 0.02 vs none, by one-factor ANOVA. a P < 0.01 vs none, by one-factor ANOVA. BMI, body mass index; ANOVA, analysis of variance.

Figure 2.

Linear relationship observed between the Greene Climacteric Scale score (top) or body mass index (kg/m2; bottom) and 24-hour urinary cortisol (μg/24 h) values in 85 postmenopausal women. Conversion to SI units: 2.759 for 24-hour cortisol level.

The 24-hour urinary cortisol level was not related to levels of total cholesterol, triglycerides, or glucose. By contrast, it was inversely related to HDL-cholesterol (CR, −0.065; 95% CI, −0.114 to −0.017; r = 0.283; P = 0.009; Fig. 3). This association remained the only one significant when the other factor inversely related to HDL (waist girth) was also entered into the stepwise analysis.

Figure 3.

Linear relationship observed between 24-hour urinary cortisol values and HDL-cholesterol level (top) or insulin resistance, evaluated by the HOMA-IR (glucose × insulin/22.5; bottom), in 85 postmenopausal women. Conversion to SI units: 0.02586 for cholesterol, 2.759 for 24-hour cortisol. HDL, high-density lipoprotein; HOMA-IR, homeostatic model assessment of insulin resistance.

The 24-hour urinary cortisol level was directly related to insulin resistance, indirectly evaluated by HOMA-IR (r = 0.377; P = 0.0004; Fig. 3). Among the other related factors, such as WHR, waist girth, weight, and BMI, only waist girth and BMI were used, after correction for collinearity. Stepwise regression analysis revealed that waist girth explained 42% and the 24-hour urinary cortisol level explained 9% of the HOMA-IR variance. BMI was not associated with 24-hour urinary cortisol variance. The linear model for HOMA-IR (r = 0.510; P = 0.0001) was determined by waist girth (CR, 0.685; 95% CI, 0.306–1.063) and 24-hour urinary cortisol level (CR, 0.097; 95% CI, 0.032–0.162).

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