Published Online
on October 28, 2002

A more recent version of this article appeared on November 19, 2002

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Submitted on July 22, 2002
Revised on September 6, 2002
Accepted on September 6, 2002

Adrenocortical, Autonomic, and Inflammatory Causes of the Metabolic Syndrome. Nested Case-Control Study

E. J. Brunner PhD^*, H. Hemingway MRCP, B. R. Walker MD, M. Page MRes, P. Clarke PhD, M. Juneja BSc, M. J. Shipley MSc, M. Kumari PhD, R. Andrew PhD, J. R. Seckl MBBS, PhD, A. Papadopoulos PhD, S. Checkley FRCP, A. Rumley PhD, G. D.O. Lowe MD, FRCP, S. A. Stansfeld PhD, and M. G. Marmot PhD, FRCP

From the International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, England; Endocrinology Unit (B.R.W., R.A., J.R.S.), Western General Hospital, University of Edinburgh, Scotland; Institute of Psychiatry (A.P., S.C.), Bethlem Royal Hospital, London, England; Department of Medicine (A.R., G.D.O.L.), Royal Infirmary, University of Glasgow, Scotland; and Department of Community Psychiatry (S.A.S.), Queen Mary and Westfield College, London, England.

^* To whom correspondence should be addressed. E-mail: e.brunner{at}ucl.ac.uk.

Background—The causes of metabolic syndrome (MS), which may be a precursor of coronary disease, are uncertain. We hypothesize that disturbances in neuroendocrine and cardiac autonomic activity (CAA) contribute to development of MS. We examine reversibility and the power of psychosocial and behavioral factors to explain the neuroendocrine adaptations that accompany MS.

Methods and Results—This was a double-blind case-control study of working men aged 45 to 63 years drawn from the Whitehall II cohort. MS cases (n=30) were compared with healthy controls (n=153). Cortisol secretion, sensitivity, and 24-hour cortisol metabolite and catecholamine output were measured over 2 days. CAA was obtained from power spectral analysis of heart rate variability (HRV) recordings. Twenty-four-hour cortisol metabolite and normetanephrine (3-methoxynorepinephrine) outputs were higher among cases than controls (+0.49, +0.45 SD, respectively). HRV and total power were lower among cases (both -0.72 SD). Serum interleukin-6, plasma C-reactive protein, and viscosity were higher among cases (+0.89, +0.51, and +0.72 SD). Lower HRV was associated with higher normetanephrine output (r=-0.19; P=0.03). Among former cases (MS 5 years previously, n=23), cortisol output, heart rate, and interleukin-6 were at the level of controls. Psychosocial factors accounted for 37% of the link between MS and normetanephrine output, and 7% to 19% for CAA. Health-related behaviors accounted for 5% to 18% of neuroendocrine differences.

Conclusions—Neuroendocrine stress axes are activated in MS. There is relative cardiac sympathetic predominance. The neuroendocrine changes may be reversible. This case-control study provides the first evidence that chronic stress may be a cause of MS. Confirmatory prospective studies are required.

Key words: norepinephrine • coronary disease • stress • metabolism • heart rate

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