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Ortiz R, Zhao S, Kline DM, Brock G, Carroll JE, Seeman TE, Jaffee SR, Berger JS, Golden SH, Carnethon MR, Joseph JJ. Childhood environment early life stress, caregiver warmth, and associations with the cortisol diurnal curve in adulthood: The coronary artery risk development in young adults (CARDIA) study. Psychoneuroendocrinology 2023; 149:106008. [PMID: 36599226 PMCID: PMC10029914 DOI: 10.1016/j.psyneuen.2022.106008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Early life stress (ELS) is associated with increased morbidity and mortality across the lifecourse. Studies observing a relationship between ELS and stress physiology (cortisol), may help explain the connection to poor health outcomes, but have been limited by cortisol measures used. PURPOSE We examined the association between ELS measured by a Risky Family (RF) environment questionnaire, and adult diurnal cortisol profile inclusive of multiple cortisol measures. METHODS RF and cortisol were collected from Coronary Artery Risk Development in Young Adults Study participants at follow-up (Year 15). Complete case (n = 672) data were included in multi-variable regression analyses with log transformed cortisol measures (outcomes) including wake-up cortisol, cortisol awakening response [CAR], AUC and five other cortisol diurnal curve measures. RESULTS Participants were age 39.9 + /- 3.7 years and 51.6% Black. For every 1 unit increase in RF, there was a 1.4% greater wake-up cortisol and flatter CAR after adjustment for age, sex, income, and smoking (B=0.014, p = 0.023; B=-0.014, p = 0.028, respectively). Each unit increase in caregiver warmth/affection was associated with a 6.9% higher (steeper) CAR (B=0.069, p = 0.03). Results remained significant after adjusting for other covariates except social support in adulthood. An interaction between child abuse and caregiver warmth was nearly significant (p = 0.068), such that for those with exposure to the greatest caregiver warmth and lowest child abuse, CAR was steepest CONCLUSIONS: We demonstrate that ELS is associated with altered cortisol regulation in adulthood. However, further research is needed to assess how healthy relationships throughout the life course may modulate cortisol regulation in adulthood.
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Affiliation(s)
- Robin Ortiz
- Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, USA; Departments of Pediatrics and Population Health, New York University, Grossman School of Medicine, New York, NY, USA.
| | - Songzhu Zhao
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - David M Kline
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Guy Brock
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Judith E Carroll
- The University of California, Los Angeles, David Geffen School of Medicine, Jane and Terri Semel Institute for Neuroscience and Human Behavior, Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, USA
| | - Teresa E Seeman
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sara R Jaffee
- Department of Psychology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey S Berger
- Departments of Medicine and Surgery, New York University, Grossman School of Medicine, New York, NY, USA; Center for the Prevention of Cardiovascular Disease, Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Sherita H Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH, USA
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Ortiz R, Kluwe B, Lazarus S, Teruel MN, Joseph JJ. Cortisol and cardiometabolic disease: a target for advancing health equity. Trends Endocrinol Metab 2022; 33:786-797. [PMID: 36266164 PMCID: PMC9676046 DOI: 10.1016/j.tem.2022.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022]
Abstract
Stress, in both intrinsic psychosocial and extrinsic physical environmental forms, can impact the development of, and outcomes in, cardiovascular disease (CVD) through allostatic load. Cortisol is a core hormonal mediator of allostatic load produced in response to various stresses. Alterations in morning serum cortisol and daily diurnal cortisol have been associated with adiposity, dyslipidemia, incident diabetes, and CVDs such as hypertension. The review examines the role of cortisol as a key mechanistic link between stress physiology and cardiometabolic disease. Importantly, we discuss the role of targeting cortisol through pharmacological, behavioral, and environmental interventions to advance health equity in cardiometabolic disease.
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Affiliation(s)
- Robin Ortiz
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Institute for Excellence of Health Equity, NYU Langone Health, New York, NY, USA
| | - Bjorn Kluwe
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sophie Lazarus
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Mary N Teruel
- Department of Biochemistry and the Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY, USA
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH, USA.
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Ortiz R, Joseph JJ, Branas CC, MacDonald JM, Nguemeni Tiako MJ, Oyekanmi K, South EC. Advancing health equity through integrated biology and population health research: A community-based sample cortisol feasibility and exploratory study. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 11:100145. [PMID: 35757172 PMCID: PMC9228000 DOI: 10.1016/j.cpnec.2022.100145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 12/21/2022] Open
Abstract
Background Community-based research inclusive of self-assessment and objective environmental metrics can be enhanced by the collection of biomarker data in unity toward assessing the health impacts of the totality of environmental stress driven by structural racism. Cortisol dynamic range (CDR), a measure of chronic stress burden, may underpin place-based connections to health, but a gap remains in elucidating community-based CDR methodology. Purpose To 1) assess the feasibility of cortisol collection and CDR measurement in a community-based study with home-based, participant-directed specimen collection, and 2) explore the association between CDR and other individual and environmental measures in a sample of predominantly Black participants. Methods: In this cross-sectional, observational study in predominantly Black urban neighborhoods, participants (n = 73) completed health assessments and in-home, self-collected salivary cortisol. For feasibility, CDR (peak-nadir) was compared to cortisol awakening response (CAR) slope over time. Comparisons of CDR quartile by person and place variables were explored (ANOVA). Results The cohort (77% Black, 39.7% <$15 k/year income, high perceived stress) completed 98.6% of cortisol collection timepoints. CDR was calculated in all participants without interruptions to sleep-wake cycle as seen with CAR collection. Participants in the lowest quartile of CDR were the oldest (p = 0.03) with lowest reported mental health (p = 0.048) with no associations seen for CAR. Conclusion Participant-collected 10.13039/501100011622CDR is more feasible than cortisol measures dependent on slopes over time in a community-based, predominately Black cohort with exploratory findings supporting relevance to outcomes of interest to future work. Future community-based studies should integrate CDR with environment and psychosocial measures. Biological and social metrics can enhance community studies of structural racism. Cortisol dynamic range (CDR) may reflect the burden of chronic stress in a community. In-home, participant-collected salivary cortisol is feasible with in-field guidance. CDR may be more feasible in community-based study than measures dependent on time. Greatest CDR is seen with youngest age and best self-reported mental health.
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Affiliation(s)
- Robin Ortiz
- Departments of Pediatrics and Population Health, New York University, Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
- Institute for Excellence in Health Equity, New York University Langone Health, New York, Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
- National Clinician Scholars Program, University of Pennsylvania Perelman School of Medicine, 1300 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Corresponding author. Departments of Pediatrics and Population Health, New York University, Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Joshua J. Joseph
- The Ohio State University, Wexner Medical Center, Division of Endocrinology, Diabetes and Metabolism, 579 McCampbell Hall, Columbus, OH, 43210, USA
| | - Charlie C. Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Rm 1508, New York, NY, 10032, USA
| | - John M. MacDonald
- Department of Criminology, School of Arts and Sciences, University of Pennsylvania, 558 McNeil Building, Locus Walk, Philadelphia, PA, 19104, USA
| | | | - Kehinde Oyekanmi
- Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Urban Health Lab, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Eugenia C. South
- Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Urban Health Lab, University of Pennsylvania, Philadelphia, PA, 19104, USA
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