Long-term cortisol exposure and echocardiographic measures of cardiac structure and function

Background Chronic activation of the hypothalamic–pituitary–adrenal axis due to long-term stress, reflected by elevated hair cortisol concentration (HCC), has been associated with increased cardiovascular disease risk. However, whether prolonged cortisol exposure is linked to alterations in cardiac structure and function remains unclear. Methods In a population-based cohort of 3005 individuals aged 50–64 years in Sweden, HCC was measured and analysed in relation to 19 echocardiographic parameters reflecting cardiac morphology and function. Through linear regression models the association between HCC and echocardiographic parameters was analysed, adjusting for relevant confounders and complemented by sensitivity analyses to assess influence of extreme values and to evaluate potential non-linearity. Results No significant association between HCC and three broad principal component analysis-derived cardiac phenotypes was observed. Across 19 individual echocardiographic measures, effect estimates were generally small and CIs largely included the null. Left Atrial End-Systolic Volume Index (LAESVI) was the only measure showing a false discovery rate-adjusted significant association with HCC; however the magnitude of this association was modest, with β=0.178 SD per one-unit increase in log10-HCC, corresponding to approximately 0.734 mL/m² higher LAESVI across the IQR of HCC (~2.9% of the cohort median). Conclusions Taken together, in this population-based study, these findings provide little evidence that HCC is associated with clinically meaningful differences in cardiac structure or function in generally healthy middle-aged adults.