Increased cortisol level: a possible link between climacteric symptoms and cardiovascular risk factors

Context: Climacteric symptoms may increase the risk for cardiovascular diseases through still elusive mechanisms. Increased cortisol release may favor atherosclerosis. Objective: In this study we tested whether climacteric symptoms are associated with an increase in cortisol levels.Methods: Cross sectional investigation on women in early menopause consecutively enrolled between January and June 2009.Setting: Menopause outpatient service at University Hospital.Patients: Eighty-five healthy women, 6 months to 5 years in postmenopause. Interventions: Twenty-four urinary cortisol and scores of the Greene’s climacteric scale were evaluated. Anthropometric parameters, and fasting blood samples for the determination of HDL-cholesterol, total cholesterol, triglycerides, glucose and insulin were measured. Body mass index, waist/hip ratio and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Main Outcome: Relation between Greene’s climacteric scores and 24-h urinary cortisol, and between 24-h urinary cortisol and lipids or insulin resistance.Results: Variance of twenty-four hour urinary cortisol was explained for 32.5% and 10.3% by the Greene’s score for climacteric symptoms (CR 1.343; 95%CI 0.441, 2.246) and BMI (CR 4.469; 95% CI 1.259, 7.678), respectively (r=0.428; p=0.0003). Twenty-four h urinary cortisol was inversely related to HDL-cholesterol (CR -0.065; 95% CI -0.114,-0.017)(r=0.283; p=0.009), and along with waist girth (CR 0.685; 95%CI 0.306, 1.063) to HOMA-IR (CR 0.097; 95%CI 0.032, 0.162) (r=0.510;p=0.0001). Conclusions: In early postmenopausal women score of the Greene’s climacteric scale is associated with increased 24-h urinary cortisol. Increased cortisol is associated with known risk factors for cardiovascular disease such as insulin resistance and decreased HDL-cholesterol.