Graduate Thesis Or Dissertation
 

Cortisol, abdominal obesity, and reductions in inflammation after cardiac rehabilitation in non-diabetic coronary patients

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  • Abdominal obesity is a part of insulin resistance syndrome that is closely linked to increased risk of coronary artery disease (CAD). Because fat tissue acts as an endocrine target and source of hormone production, increased metabolism or production of chemical messengers in fat tissue may result in metabolic perturbations that contribute to occurrence and recurrence of coronary events. This dissertation research entails two separate approaches. The first study, a cross-sectional analysis, sought to determine whether serum cortisol responses to oral glucose loading are associated with abdominal obesity, non-esterified fatty acid (NEFA) suppression, and self-reported symptoms of depression in 26 non-diabetic coronary patients. We conclude that lower cortisol responses to oral glucose loading are associated with abdominal obesity, reduced NEFA suppression, and fewer symptoms of depression (P≤0.028). Future prospective studies should determine whether psychosocial risk factors, such as depression and anxiety, increase cortisol production, whether increases in cortisol production act synergistically with a positive energy balance in the development of abdominal obesity, and whether increases in abdominal obesity lead to increases in cortisol metabolism and insulin resistance. C-reactive protein (CRP) is a marker of low-grade inflammation that is associated with increased risk for recurrent events in coronary patients. Fat tissue also secretes proinflammatory cytokines that stimulate hepatic production of CRP. Thus, the second study, an intervention study, sought to determine whether the first three months of cardiac rehabilitation could reduce serum concentrations of CRP and the proinflammatory cytokine, tumor necrosis factor-α (TNF-α), in our non-diabetic coronary patients (N=26). Results from the intervention study showed significant reductions in serum CRP levels (P=0.012) that were associated with reductions in waist circumferences after cardiac rehabilitation (r=0.39, P=0.049). However, changes in serum TNF-α levels after cardiac rehabilitation were nonsignificant (P=0.869). Thus, we conclude that cardiac rehabilitation may reduce the severity of low-grade inflammatory conditions, in part, through reductions in waist circumference in non-diabetic coronary patients.
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