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

Cagnacci, Angelo MD, PhD; Cannoletta, Marianna MD; Caretto, Simona MD; Zanin, Renata MD; Xholli, Anjeza MD; Volpe, Annibale MD

doi: 10.1097/gme.0b013e3181f31947
Original Articles

Objective: Vasomotor symptoms may increase the risk for cardiovascular diseases through still elusive mechanisms. Increased cortisol release may favor atherosclerosis. In this study, we tested whether vasomotor and psychological symptoms are associated with an increase in cortisol levels.

Methods: A cross-sectional investigation on women in early menopause enrolled consecutively between January and June 2009 was conducted. This study was set at a menopause outpatient service at University Hospital. Participants included 85 healthy women who were 6 months to 5 years postmenopause. The 24-hour urinary cortisol level and Greene Climacteric Scale scores were evaluated. Anthropometric parameters and fasting blood samples for the determination of high-density lipoprotein (HDL) cholesterol, total cholesterol, triglycerides, glucose, and insulin levels were measured. Body mass index, waist-to-hip ratio, and homeostatic model assessment of insulin resistance were calculated. The relation between Greene Climacteric Scale scores and 24-hour urinary cortisol level and between 24-hour urinary cortisol level and lipid levels or insulin resistance was determined.

Results: The Greene Climacteric Scale score for climacteric symptoms (coefficient of regression [CR], 1.343; 95% CI, 0.441-2.246) and body mass index (CR, 4.469; 95% CI, 1.259-7.678) explained 32.5% and 10.3%, respectively, of the variance in 24-hour urinary cortisol level (r = 0.428; P = 0.0003). Twenty-four-hour urinary cortisol level was inversely related to HDL-cholesterol level (CR, −0.065; 95% CI, −0.114 to −0.017; r = 0.283; P = 0.009) and was related to waist girth (CR, 0.685; 95% CI, 0.306-1.063) and homeostatic model assessment of insulin resistance (CR, 0.097; 95% CI, 0.032-0.162; r = 0.510; P = 0.0001).

Conclusions: In early postmenopausal women, the Greene Climacteric Scale score is associated with increased 24-hour urinary cortisol level. Increased cortisol level is associated with known risk factors for cardiovascular disease, such as insulin resistance and decreased HDL-cholesterol level.

From the Department Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.

Received April 26, 2010; revised and accepted July 14, 2010.

Support/funding: Unrestricted funds were received from the Italian Consiglio Nazionale delle Ricerche.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Angelo Cagnacci, MD, PhD, Dipartimento Integrato Materno-Infantile, Ginecologia e Ostetrica, Azienda Ospedaliero-Universitaria di Modena, via del Pozzo 71, 41100 Modena, Italy. E-mail:

©2011The North American Menopause Society