Does cortisol increase the risk of thrombosis (blood clots)?

From the Guidelines

Cortisol can potentially increase the risk of blood clots, though the relationship is complex, and this risk is particularly concerning for individuals taking corticosteroid medications like prednisone, especially at higher doses or for extended periods. Chronically elevated cortisol levels, whether from stress, Cushing's syndrome, or long-term corticosteroid medication use, can promote hypercoagulability (increased blood clotting tendency) 1. Cortisol affects multiple clotting factors, increases platelet aggregation, and can damage blood vessel linings, all of which contribute to clot formation. Additionally, cortisol promotes inflammation and raises blood glucose levels, which further increases clotting risk.

Some key points to consider when evaluating the risk of clots associated with cortisol include:

• The dose and duration of corticosteroid therapy, with higher doses and longer durations associated with a greater risk of adverse effects, including thrombotic events 1
• The presence of other risk factors, such as smoking, obesity, or a sedentary lifestyle, which can further increase the risk of blood clots
• The importance of balanced cortisol levels for normal function, and the potential for dysregulation of the coagulation system when levels remain high for extended periods 1

It is essential to weigh the benefits and risks of corticosteroid therapy, particularly in patients with a history of thrombotic events or those at high risk of developing such events. The use of corticosteroids should be carefully monitored, and alternative treatments should be considered when possible, to minimize the risk of adverse effects, including blood clots.

From the Research

Cortisol and Clotting Risk

• The relationship between cortisol and clotting risk is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, study 6 mentions thromboembolic disease as one of the comorbidities associated with Cushing syndrome, which is characterized by chronic hypersecretion of cortisol.
• The study suggests that even after long-term remission, patients with Cushing syndrome may still experience increased morbidity and mortality, including thromboembolic events 6.
• Study 4 notes that corticosteroids, which are related to cortisol, can cause disorders of coagulation and fibrinolysis, which may increase the risk of clotting.
• Study 5 mentions that mild hypercortisolism can increase the risk of cardiovascular events, which may include thromboembolic events.

Mechanisms and Treatment

• The exact mechanisms by which cortisol may increase the risk of clotting are not clearly defined in the provided studies.
• However, study 4 suggests that an imbalance between vasoconstriction and vasodilation, as well as increased oxidative stress and renin-angiotensin system activation, may contribute to the development of thromboembolic events.
• Treatment of Cushing syndrome and mild hypercortisolism typically involves normalizing cortisol levels, which may help reduce the risk of clotting 2, 3, 5.
• Study 5 notes that surgery may be an effective treatment option for some patients with mild hypercortisolism, while medical therapy may be necessary for others.
• Study 6 emphasizes the importance of early recognition and effective management of patients with Cushing syndrome, including active treatment of related comorbid conditions and surveillance for thromboembolic events.