Lowering Cortisol Levels Can Ease Heart Issues in Certain Patients
Due to its effects on heart tissue, high levels of cortisol, like those seen in Cushing’s syndrome, may play a role in the development of cardiomyopathies — diseases of the heart muscle that make it harder for the heart to pump blood to the rest of the body — a recent study reported.
Thus, controlling cortisol levels in patients with Cushing’s complicated by such cardiovascular diseases can improve heart health outcomes, the study’s findings also indicated.
The study, “Clinical Characteristics for the Improvement of Cushing’s Syndrome Complicated With Cardiomyopathy After Treatment With a Literature Review,” was published in the journal Frontiers in Cardiovascular Medicine.
Cushing’s syndrome is a disorder characterized by an excessive amount of the stress hormone cortisol in the body. The disease has numerous causes, including tumors in the adrenal glands, located above the kidneys, or in the brain’s pituitary gland — the gland that stimulates the adrenal glands to produce cortisol.
Metabolic issues, such as high blood pressure, impaired glucose (sugar) tolerance, and high levels of lipids (fatty molecules) in the blood, also can complicate Cushing’s. Additionally, due to high cortisol levels, patients with the disorder are at a higher risk of developing opportunistic infections, blood clotting problems, and heart issues.
Cushing’s also is associated with an increased risk of mortality, which can be even higher when the condition induces the development of cardiomyopathies.
Now, researchers in China reviewed clinical data from a group of people with Cushing’s complicated by heart diseases to evaluate how these patients were diagnosed and managed.
The goal was to “further understand the diagnosis, treatment, and management of these cases,” the team wrote.
To that end, information from individuals followed at Peking Union Medical College Hospital was combined with data from other Cushing’s patients, as reported in the literature. In total, 19 people with Cushing’s associated with cardiomyopathies, and 242 patients without heart diseases (controls) were included in the study.
Among the 19 patients with cardiomyopathies were 10 males and nine females. The mean age at diagnosis was 35.33 years, and the average body mass index (BMI), a body fat measure, was 28.78 kg/m2. Of note, normal BMI is 18.5 to less than 25. Thus, these patients were overweight, with a BMI between 25 and less than 30.
Most of those with cardiac issues had either pituitary tumors (42.11%) or adrenal tumors (36.84%).
More than half (78.95%) of these patients had dilated cardiomyopathies (DCM), a type of heart disease in which the chambers of the heart stretch and become thin. The other 21.05% had hypertrophic cardiomyopathies (HCM), another type of heart disease in which the heart muscle becomes abnormally thick.
Additionally, 11 patients had high blood pressure, five had diabetes, eight had high levels of lipids in the bloodstream, and six had low levels of potassium in the blood.
More than half of the patients with cardiomyopathies had difficulty breathing, while five had no relevant symptoms when their cardiac diseases were detected via ultrasound. Additionally, based on electrocardiograph (ECG) examination, which evaluates heart rhythm, 10 of 13 patients were found to have some sort of heartbeat irregularity.
In patients with DCM, the left ventricle — the left lower chamber of the heart — ranged from 56 to 79 mm with an average of 63.77 mm at the point in the heart’s pumping cycle where it would be at its largest. Normally, the average diameter at that point is closer to 47 mm.
The ejection fraction, which measures how much blood the left ventricle pumps out, was decreased in these patients, with an average of 30.39% — normally, this measure is closer to 50–70%.
In the few HCM patients, the left ventricle was 53 mm and 50 mm at the point in the heart’s pumping cycle where it would be at its largest, which is much closer to normal. Additionally, the ejection fraction was 70% and 69%, also within a normal range.
Among the 19 patients with Cushing’s complicated with cardiomyopathies, eight underwent pituitary surgery and seven had adrenal surgery in an attempt to tackle the root cause of the disease.
Further follow-up in 16 patients revealed that, in 12 of them, heart structure and function were significantly improved or restored following remission of their high cortisol levels.
However, three patients showed no significant improvements, with two of them being unable to undergo surgery due to severe heart failure.
Of the patients with DCM, 10 of 13 improved significantly, and even completely recovered with regard to their heart structure and function once cortisol levels were kept under control. Their ejection fraction also increased by an average of about 25.78%.
Meanwhile, one of the HCM patients had normal heart structure within 10 months, while the other individual recovered completely with regard to Cushing’s disease symptoms. That patient saw all heart issues resolved by just one month after surgery, the researchers noted.
“In the cases of [Cushing’s syndrome] complicated with cardiomyopathies in this paper, cardiac function recovered in a short time after hypercortisolemia [high cortisol] remission, showing a close relationship with the effect of overproduction of cortisol,” the researchers wrote.
This further suggests that “apart from the effects of metabolic changes caused by hypercortisolism, the direct effect of cortisol on the myocardium [heart muscle] should be considered,” the team wrote.
The researchers then compared the clinical features of patients with ACTH-dependent Cushing’s with and without cardiomyopathies. Of note, ACTH-dependent Cushing’s is a form of the disease in which the excessive release of adrenocorticotropic hormone (ACTH) from pituitary tumors leads to increased cortisol production by the adrenal glands.
The results showed that the number of males and the proportion of those with high levels of lipids in their blood was increased in those with cardiomyopathies. There was no difference when it came to age, BMI, and the proportion of those with high blood pressure or diabetes between the groups.
“Cortisol plays an important role in the development of cardiomyopathies in [Cushing’s], and the cardiomyopathies can be greatly improved with remission of hypercortisolemia,” the researchers concluded.