Salivary cortisol and α-amylase: subclinical indicators of stress as cardiometabolic risk

Currently, the potential for cardiovascular (CV) stress-induced risk is primarily based on the theoretical (obvious) side effects of stress on the CV system. Salivary cortisol and α-amylase, produced respectively by the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic-adrenomedullary (SAM) system during stress response, are still not included in the routine evaluation of CV risk and require additional and definitive validation. Therefore, this article overviews studies published between 2010 and 2015, in which salivary cortisol and α-amylase were measured as stress biomarkers to examine their associations with CV/CMR (cardiometabolic risk) clinical and subclinical indicators. A comprehensive search of PubMed, Web of Science and Scopus electronic databases was performed, and 54 key articles related to the use of salivary cortisol and α-amylase as subclinical indicators of stress and CV/CMR factors, including studies that emphasized methodological biases that could influence the accuracy of study outcomes, were ultimately identified. Overall, the biological impact of stress measured by salivary cortisol and α-amylase was associated with CV/CMR factors. Results supported the use of salivary cortisol and α-amylase as potential diagnostic tools for detecting stress-induced cardiac diseases and especially to describe the mechanisms by which stress potentially contributes to the pathogenesis and outcomes of CV diseases

Salivary cortisol and α-amylase production at awakening is associated with positivity (POS) levels in healthy young subjects

A large variety of positive outcomes including social adjustment, psychological well-being and health, have been recently closely associated with positivity (POS). On the assumption that differences in the POS degree might be associated with different individual neuroendocrine assets that enables people to cope effectively with stress, the present study examined the association between POS, salivary cortisol and α-Amylase (α-Amy) production in a group of healthy male volunteers university students, respectively scoring high (POS-H, N = 10) and low (POS-L, N = 10) in POS. Participants were selected from a larger sample of 300 students of the Medical School at Sapienza University of Rome on the basis of their positivity level: POS was analysed and the upper and lower 25% were invited to participate in this new study. The findings report a distinct salivary cortisol and α-Amy production in the study population: in comparison to the POS-H group, the POS-L subjects presented a lower salivary cortisol awake response (CAR) and a flattened α-Amy production at 30 and 60 min after awakening. In addition, salivary cortisol and α-Amy areas under the curve (AUCs), which were calculated as indicators of the two subclinical biomarkers production during the first hour after awakening, resulted significantly lower in the POS-L group in comparison to the POS-H group. Further studies on larger and different populations are needed to definitively confirm that the different cortisol and α-Amy secretion patterns between POS-H and POS-L individuals is associated with a potentially better capacity to preserving an adequate quality of life in individuals being equipped with a system apparently able to better respond to external and/or internal stimuli. Lastly, a better understanding of the biological correlates of POS is crucial to design psychological interventions able to take advantage of individuals’ assets and thus to integrate and strengthen the efficacy of traditional medications

Serum testosterone and depressive symptoms in severe OSA patients

Obstructive sleep apnoea (OSA), also characterised by hypoxia-related sleep- fragmentation, has been studied in relation to depression and serum testosterone deficit. In middle-aged men, it has been reported the association between depressive mood and low serum testosterone level; however, no data are available about this association in OSA patients. Therefore, the aim of this study was to investigate in adult obese males, affected by severe OSA, the relationship between serum testosterone concentration and depressive symptoms, in order to identify among all measured parameters (serum testosterone morning concentration, polysomnography parameters, body mass index, Epworth Sleepiness Scale) those predictors for OSA-related depression. Forty patients diagnosed with severe OSA and forty subjects for the control-matched group were enroled in the study. The results indicated that the serum testosterone in OSA group was significantly lower than in controls. In addition, the OSA group presented a level of depression although moderate, yet significantly higher than controls. Furthermore, a statistically significant inverse correlation has been found between serum testosterone level and depressive symptoms. Among all variables, serum testosterone level was shown to be the only independent variable significantly predictor for depression in OSA patients. © 2012 Blackwell Verlag GmbH

Current perspectives in stress research and cardiometabolic risk

The most important objective of this research was to analyze and discuss the current relationship between the level of stress perception and the consequences on cardiometabolic risk in population. The study was based on a literature review, including books, published articles and internet information, as well as on the author's own experience in this field, regarding the most important concepts about stress, the mediators and systems involved, methods of assessment and evidences about the influences of stress on cardiac, endocrine and metabolic system. Stress and coping with stress have been identified as important variables affecting health, now recognized to be involved in pathogenesis of many diseases: cardiometabolic, respiratory and digestive pathologies, cancer, neuroendocrine and psychiatric disorders. Glucocorticoids, catecholamines, pro- and antiinfla-mmatory cytokines and the parasympathetic nervous system are involved in the adaptation to stressors. The overload of these allostatic systems is characterized by persistent high levels of stress mediators and damaging effects on human health. The stress assessment combine the rating scales for self-evaluation and the laboratory tests. From the medical point of view, the most important step forward in the stress research was made by using salivary stress markers. Measuring cortisol, alpha-amylase, or dehydroepiandrosterone in saliva became a reliable method of investigating stress in human because avoid venipuncture and offer the possibility of self-collection at home or at work, several times per day. Stress markers were significantly increased in metabolic syndrome, hypertension, stroke, ischemic heart disease and heart failure

Awakening responses and diurnal fluctuations of salivary cortisol, DHEA-S and alpha-amylase in healthy male subjects

OBJECTIVES: Because the cortisol awakening response (CAR) has received increasing attention as a useful index of adrenocortical activity, the primary objective of this study was to investigate the presence of an awakening response for various salivary biomarkers of adrenocortical activity, including dehydroepiandrosterone-sulphate (DHEA-S), which acts as a cortisol antagonist, and alpha-amylase, which is a predictor of circulating catecholamine activity. Salivary biological indicators are considered to be valuable markers of hypothalamus-pituitary-adrenal (HPA) axis diurnal activity. METHODS: In an attempt to overcome problems associated with non-adherence to the requested sampling protocol, only young, healthy males with a physiological CAR value (defined as a 50% increase in salivary cortisol within 30 mm after waking) were included in the study (67 out of 102 who initially enrolled met this criterion). RESULTS: Our results suggested that, as is already known for cortisol, DHEA-S and alpha-amylase have significant awakening responses. In addition, daily profile of salivary cortisol, alpha-amylase and DHEA-S fluctuations were analysed. Significant correlations were found between salivary cortisol, DHEA-S and alpha-amylase levels. The results showed that cortisol and DHEA-S concentrations were inversely correlated with alpha-amylase levels. DISCUSSION: This correlation confirmed the distinctiveness of the two regulatory systems: salivary cortisol and DHEA-S concentrations reflect the activity of the HPA axis, whereas alpha-amylase activity is more closely related to sympathetic activity. In addition, the present study emphasizes the potential value of saliva collection (which is both easy and stress-free) in monitoring changes of adrenal function, confirming that multiple sampling (especially within 1 h after awakening) is necessary to reliably characterise biomarker activity when investigating neuroendocrine changes under various conditions

Diurnal trajectories of salivary cortisol, salivary α-amylase and psychological profiles in oral lichen planus patients.

Although many reports have been published on the link between oral lichen planus (OLP) and the stress-related neuro-psycho-endocrine clinical features of the disease over the last 20 years, the data still remain controversial. Therefore, the aim of this study was to explore the personality traits of OLP subjects and assess the subjects' capability of coping with stress challenges. Cortisol and alpha-amylase were measured as reliable markers of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) activities in salivary samples collected by the participants at their home during the sampling day (07:30, 12:00, and 19:30). Compared with the healthy controls, the OLP patients demonstrated a less effective coping ability, had higher scores in stress perception and loneliness, and had no significant variation in their anxiety and depressive symptoms. The OLP patients also showed dysregulation of the HPA axis activity with a significant reduction of diurnal salivary cortisol production, which was particularly significant in the morning hours. No significant variation was found in the OLP salivary alpha-amylase diurnal fluctuation and production, which was measured at the same time point as that for cortisol. In conclusion, we report that OLP subjects had a reduced capability of coping with stress events and presented a dysregulation of HPA axis activity with hypocortisolism detected in the morning hours