AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Adrenal Hormone Imbalance and Cardiovascular Risk: A Real-World Analysis of Serum Cortisol and Aldosterone Levels, and Outcomes
By Cross LM, Hammonds K, Arshad MS et al.
Background: Elevated aldosterone and cortisol levels are increasingly recognized as key contributors to cardiovascular, kidney, and metabolic diseases. Research conducted on their association with clinical outcomes in real-world populations, however, is sparse. We examined patterns of use of aldosterone and cortisol measurements in a large integrated health care system in terms of frequency and commonly tested subgroups, and looked at the association of elevated levels with adverse outcomes. Methods: This retrospective cohort study included patients within the Baylor Scott & White Health system who underwent aldosterone and/or cortisol testing between January 2022 and January 2025. Using electronic health record (EHR), we compared characteristics of patients tested for aldosterone, cortisol, or both, and examined the association between elevated hormone levels (defined per laboratory standards) and mortality, incident atrial fibrillation (AF), heart failure (HF), stroke, and chronic kidney disease (CKD). We included serum, salivary, or urinary cortisol, and serum aldosterone. Unadjusted log rank tests were used for mortality, and Gray’s test (with mortality as competing risk) for other outcomes, and unadjusted cox models for hazard ratio estimates. Results: The final sample included 23,011 patients; 14,161 had only a cortisol measurement, 6,760 had only an aldosterone measurement and 2,090 had both. Among patients with cortisol measurements, those with elevated cortisol had a higher risk of all-cause mortality compared with those with normal cortisol levels (HR=1.87 {1.19, 2.92}; p=0.01), with no association observed for incident AF, HF, stroke, or CKD (all p>0.05). Among patients with aldosterone measurements, elevated aldosterone was associated with increased risk of all-cause mortality (HR= 3.24 {1.55, 6.75}; p<0.01), incident AF (p<0.01), stroke (p=0.01), and CKD (p<0.01), but not incident HF (p=0.14), compared to normal aldosterone. Among patients with both measurements, concomitant elevation of cortisol and aldosterone was rare (n=12), limiting assessment of combined effects. Discussion: Both aldosterone and cortisol levels are associated with all-cause mortality, and serum aldosterone is additionally associated with several chronic health outcomes. The data are limited by the varying clinical indications for these tests in the real-world setting. Prospective studies are needed to evaluate the impact in populations who have not been selected based on their testing status, and in patients with concurrent elevations of both hormones.