Salivary cortisol levels are associated with outcomes of weight reduction therapy in obese Japanese patients
Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.Metabolism: clinical and experimental (Impact Factor: 3.89). 08/2011; 61(2):255-61. DOI: 10.1016/j.metabol.2011.06.023
Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis can increase the risk of cardiovascular disease (CVD). However, the detailed relationships of HPA axis activity with weight reduction and CVD risk factors in obese patients have not been examined. This study was designed to elucidate the associations of salivary cortisol levels with weight reduction and CVD risk factors in obese patients. As a marker of HPA axis activity, we measured the morning salivary cortisol levels of 83 obese Japanese outpatients. We also examined metabolic parameters, inflammatory markers, and indicators of arterial stiffness, that is, the pulse wave velocity and cardio-ankle vascular index. All 83 obese patients underwent 3-month weight reduction therapy with lifestyle modification. At the baseline, multivariate regression analysis revealed that only logarithmic transformation of C-reactive protein (β = 0.258, P < .05) and cardio-ankle vascular index (β = 0.233, P < .05) were independent determinants of the salivary cortisol levels. However, other metabolic parameters were not significantly associated with the salivary cortisol levels. In addition, lower salivary cortisol levels and higher body weight at the baseline were the only independent determinants of successful weight loss through the weight reduction therapy (P < .01). The present study demonstrates that the baseline morning salivary cortisol levels are significantly associated with the levels of an inflammatory marker, arterial stiffness, and successful weight reduction in obese patients. Therefore, salivary cortisol could be a useful marker for assessing and managing body weight and CVD risk factors in obese patients.
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ABSTRACT: Aims: The incidence of cardiovascular events increases after a large earthquake, but the mechanism is not fully understood. The cardio-ankle vascular index (CAVI) reflects the stiffness of the artery from the origin of the aorta to the ankles and is independent of blood pressure. To determine the effect of a major earthquake on CAVI in healthy volunteers and in patients with cardiovascular risks. Methods and results: Our hospital is situated about 300 km from the epicenter of the earthquake that occurred in Japan in 2011. In study 1, healthy volunteers were included. In study 2, patients with cardiovascular factors were included. In study 1, the mean CAVI was 7.3±1.0 just after the earthquake. After 7-14 days, the mean CAVI had decreased to 6.8±1.1 (compared to firstt measurement, p<0.05). Furthermore, the CAVI value 30 days after the earthquake was 7.0±1.1. The blood pressure did not change during these 30 days. In study 2, the mean CAVI 12 and 6 months before the earthquake were 8.95±0.76 and 8.99±0.83, respectively. The CAVI was 9.34±1.0 just after the earthquake and had decreased to 8.83±0.76 6 months later (compared to after the earthquake, p< 0.05). The blood pressure increased slightly at the time of earthquake, but was not significantly different from before the earthquake. Conclusions: CAVI increased in healthy people and also in patients with cardiovascular risks just after the earthquake, even far from the epicenter.
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ABSTRACT: Arterial stiffness has been identified as an independent predictor of prognostic outcomes for patients with cardiovascular disease. Although measurement of pulse wave velocity has been a widely accepted noninvasive approach to the assessment of arterial stiffness, its accuracy is hampered by changes in blood pressure. Taking the exponential relation between intravascular pressure and arterial diameter into consideration, a stiffness parameter can be obtained by plotting the natural logarithm of systolic-diastolic pressure ratio against the arterial wall extensibility. Cardio-ankle vascular index (CAVI), which is calculated based on the stiffness parameter thus obtained, is theoretically independent of changes in blood pressure. With this distinct advantage, CAVI has been widely applied clinically to assess arterial stiffness in subjects with known cardiovascular diseases including those with diagnosed atherosclerosis, coronary heart disease, and stroke as well as those at risk, including those with hypertension, diabetes, the elderly, and the obese. Because of its enhanced sensitivity, not only has the index been used to discern subtle changes in the disease process, it has also been utilized in studying normal individuals to assess their potential risks of developing cardiovascular diseases. The primary aims of assessing arterial stiffness using CAVI are not only to aid in early detection of arteriosclerosis to allow timely treatment and change in lifestyle, but also to quantitatively evaluate the progression of disease and the effectiveness of treatment. Despite its merit of being unaffected by blood pressure, discretion in data interpretation is suggested because an elevated CAVI represents not just vascular stiffness caused by pathological changes in the arterial wall, but can also be attributed to an increased vascular tone brought about by smooth muscle contraction. Moreover, certain patient populations, such as those with an ankle-brachial index < 0.9, may give falsely low CAVI and are suggested to be excluded from study.
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