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.

当前，心血管（cardiovascular, CV）应激诱导风险的评估潜力，主要基于应激对心血管系统产生的理论层面（已明确）的副作用。在应激反应过程中，分别由下丘脑-垂体-肾上腺轴（hypothalamus-pituitary-adrenal axis, HPA）与交感神经-肾上腺髓质系统（sympathetic-adrenomedullary system, SAM）分泌的唾液皮质醇（salivary cortisol）与α-淀粉酶（α-amylase），尚未被纳入心血管风险的常规评估体系，仍需开展针对性的确定性验证研究。为此，本文综述了2010年至2015年间发表的相关研究，上述研究以唾液皮质醇与α-淀粉酶作为应激生物标志物，探讨其与心脏代谢风险（cardiometabolic risk, CMR）的临床及亚临床指标之间的关联。研究团队对PubMed、Web of Science及Scopus三大电子数据库进行了全面检索，最终筛选出54篇与唾液皮质醇、α-淀粉酶作为应激与心脏代谢风险因素的亚临床标志物相关的核心文献，其中亦包含探讨可能影响研究结果准确性的方法学偏倚的相关研究。整体而言，通过唾液皮质醇与α-淀粉酶所量化的应激生物学效应，与心脏代谢风险因素存在显著相关性。研究结果支持将唾液皮质醇与α-淀粉酶作为潜在诊断工具，用于检测应激诱导性心脏疾病，尤其可为阐释应激参与心血管疾病发病机制与疾病转归的具体通路提供依据。