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coronary artery disease, cortisol, stress, type A behavior



  1. Ryden, Mireille MSc
  2. Hedback, Bo MD, PhD
  3. Jonasson, Lena MD, PhD


PURPOSE: It has been shown that behavioral therapy has effects on stress behavior in patients with coronary artery disease. Salivary cortisol measurements are widely used to assess psychological stress, stress reactivity, or both. The aim of this study was to investigate whether improved stress behavior in type A patients with coronary artery disease involved changes in cortisol secretion pattern.


METHODS: Twenty-four male patients were identified as type A individuals and completed a 12-month cognitive-behavioral stress management program. Stress behavior was evaluated by using a validated questionnaire. Morning and evening salivary cortisol levels were measured over 3 consecutive days at baseline and after 12 months.


RESULTS: Although the patients showed a significant improvement in psychosocial well-being after 12 months, their basal cortisol levels or diurnal rhythm of cortisol did not change. There was no correlation between stress score and cortisol levels.


CONCLUSIONS: The value of salivary cortisol as both a stress marker and a new cardiovascular risk factor has been discussed but the data from this small pilot study raise the question of its utility as a stress marker in cardiac rehabilitation.