Cortisol on circadian rhythm and its effect on cardiovascular system

Nor Amira Syahira Mohd Azmi, Norsham Juliana*, Sahar Azmani, Nadia Mohd Effendy, Izuddin Fahmy Abu, Nur Islami Mohd Fahmi Teng, Srijit Das

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

84 Citations (Scopus)


The synthesis and secretion of cortisol are controlled by the hypothalamic–pituitary–adrenal axis. Cortisol exhibits a proper 24-h circadian rhythm that affects the brain, the autonomic nervous system, the heart, and the vasculature that prepares the cardiovascular system for optimal function during these anticipated behavioral cycles. A literature search was conducted using databases such as Google Scholar, PubMed, and Scopus. Relevant search terms included “circadian rhythm and cardiovascular”, “cortisol”, “cortisol and acute coronary syndrome”, “cortisol and arrhythmias”, “cortisol and sudden cardiac death”, “cortisol and stroke”, and “cardioprotective agents”. A total of 120 articles were obtained on the basis of the above search. Lower levels of cortisol were seen at the beginning of sleep, while there was a rise towards the end of sleep, with the highest level reached at the moment the individual wakes up. In the present review, we discuss the role of 11β-hydroxysteroid dehydrogenase (11β-HSD1), which is a novel molecular target of interest for treating metabolic syndrome and type-2 diabetes mellitus. 11β-HSD1 is the major determinant of cortisol excess, and its inhibition alleviates metabolic abnormalities. The present review highlights the role of cortisol, which controls the circadian rhythm, and describes its effect on the cardiovascular system. The review provides a platform for future potential cardioprotective therapeutic agents.

Original languageEnglish
Article number676
Pages (from-to)1-15
Number of pages15
JournalInternational Journal of Environmental Research and Public Health
Issue number2
Publication statusPublished - Jan 2 2021


  • Biological clock
  • Cardiovascular
  • Circadian rhythm
  • Cortisol
  • Heart

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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