Cortisol Response to Psychosocial Stress in Coronary Artery Disease Patients: The Role of Mental Distress, Fatigue and Quality of Life

We aimed to explore the relationship between cortisol response to psychosocial stress, mental distress, fatigue and HRQoL in individuals with coronary artery disease (CAD) after recent acute coronary syndrome (ACS). A cross-sectional study initially included 113 subjects (88% men, 53 ± 7 years) 1–3 weeks after ACS. Cortisol response was assessed by measuring salivary cortisol during Trier Social Stress Test. Mental distress was measured with Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory, and Type D Scale-14. Fatigue symptoms were evaluated using Multidimensional Fatigue Inventory 20-items, while Health related quality of life (HRQoL) was assessed with 36-Item Short Form Medical Outcome Questionnaire. After conducting multivariable linear regression analyses, diminished cortisol response during public speech was significantly associated with higher anxiety symptoms (β=-0.224; p = 0.035), while diminished cortisol response during pre-task preparation was significantly linked with the presence of Type D personality (β=-0.290; p = 0.006; β=-0.282; p = 0.008 respectively), even after controlling for confounders (i.e., sex, age, education, NYHA functional class, beta-blockers and baseline levels of cortisol measures). We found that mental distress, but not fatigue and HRQoL, was linked with blunted cortisol response during psychosocial stress, independently of potential covariates.