Stress-induced coronary spasms: evaluating the role of serum cortisol in variant angina

Abstract Background and purpose Variant angina is a type of angina pectoralis caused by vasospasm, and the patients were recommended to take lifelong medication to suppress spasms. In addition to risk factors, mental stress can be a precipitating factor in vasospasm. We can analyze whether mental stress can affect vasospasm by analyzing the relationship between serum cortisol levels, the major stress hormone, and coronary artery vasospasm. Methods We prospectively enrolled patients who were admitted for coronary angiography from October 2022 to August 2023. We divided them into 2 groups: variant angina and those who had other angiographic findings such as insignificant, stable angina, unstable angina, or non ST segment elevation myocardial infarction. The primary endpoint was the norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) level at admission, cortisol and ACTH level at Day 1 after admission, and after discharge when visiting the outpatient clinic. We used students' t-tests to examine the differences between groups. Results A total of 196 patients were enrolled, and 23 patients were diagnosed with variant angina. The variant angina group showed significantly higher serum cortisol levels on Day1 than the other diagnosis group (10.1±3.4 µg/dL vs. 8.4±4.1 µg/dL, p-value 0.044). There were no significant differences between baseline norepinephrine, ACTH, cortisol levels, Day 1 ACTH, and serum ACTH, cortisol levels after discharge. However, the serum cortisol levels showed an increased trend than other diagnosis group (baseline cortisol 9.7±3.5 vs. 8.3±4.1, p-value 0.082; after discharge cortisol 9.3±2.7 vs. 8.6±3.6, p-value0.294). Conclusions The variant angina group had a higher level of serum cortisol level than other diagnosis groups. Also, this trend was sustained at baseline and after discharge. Further research with a large cohort is warranted.