Short-term cortisol exposure alters cardiac hypertrophic and non-hypertrophic signalling in a time-dependent manner in rainbow trout

Long-term stress induced cortisol downregulation, growth reduction and cardiac remodeling in Atlantic salmon

Stress and elevated plasma cortisol in salmonids have been linked with pathological remodeling of the heart and deterioration of fitness and welfare. However, these associations were based on biomarkers that fail to provide a retrospective view of stress. This study is the first whereby the association of long-term stress, using scale cortisol as a chronic stress biomarker, with cardiac morphology and growth performance of wild Atlantic salmon (Salmo salar) is made. Growth, heart morphology, plasma and scale cortisol levels, and expression of genes involved in cortisol regulation of the hypothalamic-pituitary-interrenal axis of undisturbed fish (control) were compared with those of fish exposed daily to stress for 8 weeks. Though scale cortisol levels showed a time-dependent accumulation in both groups, plasma and scale cortisol levels of stress group fish were 29.1% and 25.0% lower than those of control fish, respectively. These results correlated with the overall upregulation of stress-axis genes involved in the systemic negative feedback of cortisol, and local feedback via 11β-hydroxysteroid dehydrogenases, glucocorticoid and mineralocorticoid receptors in the stress treatment at the hypothalamus and pituitary level. These lower cortisol levels were, however, counterintuitive in terms of the growth performance as stress group fish grew 33.7% slower than control fish, which probably influenced the 8.4% increase in relative ventricle mass in the stress group. Though compact myocardium area between the treatments was comparable, these parameters showed significant linear correlations with scale cortisol levels, indicating the involvement of chronic stress in cardiac remodeling. These findings underscore the importance of scale cortisol as biomarker when associating chronic stress with long-term processes including cardiac remodeling.

Mental health treatment to assist in heart disease improved outcomes

In this commentary, we highlight key scientific advancements in the area of depression and heart disease dual diagnosis, to explore how new approaches can be integrated from a mental health counseling perspective. The incorporation of mental health counseling is suggested as an aid in the treatment of patients with a cardiac disease diagnosis. However, there is no structured awareness or training program for mental health counselors to associate depression with heart disease since this involves both a high level of interdisciplinary research and collaboration with existing healthcare providers. Alongside rampant calls for changes in our modern healthcare system, new holistic practices may emerge, placing mental health services at the forefront to assist in improving cardiac disease patient outcomes.