ArticlePsychoneuroendocrinology2013
Relationship between the cortisol awakening response and other features of the diurnal cortisol rhythm: the Multi-Ethnic Study of Atherosclerosis.
Article in Psychoneuroendocrinology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Use of Salivary Diurnal Cortisol as an Outcome Measure in Randomised Controlled Trials: a Systematic Review.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2016Pooled it
- Exploring the efficacy and safety of a novel standardized ashwagandha (Journal of psychopharmacology (Oxford, England) · 2023Trial
- Blunted diurnal cortisol slope as a risk marker for 9-year executive function decline: amplification by daily stress and worry severity.The journals of gerontology. Series B, Psychological sciences and social sciences · 2026Article
- Pilot randomized trial of cash transfer interventions to improve health outcomes in low income adults with poorly controlled type 2 diabetes: Study protocol and baseline characteristics.Contemporary clinical trials · 2026Article
- The Molecular Basis of Love.International journal of molecular sciences · 2025Review
- Pilot application of an inflammation and physiological dysregulation index based on noninvasive salivary biomarkers.BMC research notes · 2025Article
- Impact of a Mindfulness-Based Stress Reduction Program on Psychological Well-Being, Cortisol, and Inflammation in Women Veterans.Journal of general internal medicine · 2022Article
- The influence of maternal anxiety and cortisol during pregnancy on childhood anxiety symptoms.Psychoneuroendocrinology · 2022Article
- Childhood Trajectories of Hyperactivity/Inattention Symptoms and Diurnal Cortisol in Middle Adolescence: Results from a UK Birth Cohort.Journal of attention disorders · 2022Article
- The Cortisol Assessment List (CoAL) A tool to systematically document and evaluate cortisol assessment in blood, urine and saliva.Comprehensive psychoneuroendocrinology · 2022Review
- Curvilinear associations between family income in early childhood and the cortisol awakening response in adolescence.Psychoneuroendocrinology · 2021Article
- Differential Susceptibility to the Impact of the COVID-19 Pandemic on Working Memory, Empathy, and Perceived Stress: The Role of Cortisol and Resilience.Brain sciences · 2021Article
- The association of cortisol curve features with incident diabetes among whites and African Americans: The CARDIA study.Psychoneuroendocrinology · 2021Article
- Maternal Prenatal Cortisol and Breastfeeding Predict Infant Growth.International journal of environmental research and public health · 2020Article
- Sexual well-being and diurnal cortisol after prostate cancer treatment.Journal of health psychology · 2020Article
- The cross-sectional and longitudinal association between air pollution and salivary cortisol: Evidence from the Multi-Ethnic Study of Atherosclerosis.Environment international · 2019Article
- Relative sensitivity of cortisol indices to psychosocial and physical health factors.PloS one · 2019Article
- DNA methylation and sex-specific expression of FKBP5 as correlates of one-month bedtime cortisol levels in healthy individuals.Psychoneuroendocrinology · 2018Article
- Acute Physiologic Stress and Subsequent Anxiety Among Family Members of ICU Patients.Critical care medicine · 2018Observational
- Diurnal Cortisol Interacts With Stressful Events to Prospectively Predict Depressive Symptoms in Adolescent Girls.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2017Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
Abstract
Cumulative cortisol burden is known to influence neuropsychiatric and metabolic disorders. To better understand the relationship between daily cortisol exposure and measures of the diurnal circadian cortisol rhythm, we examined the cross-sectional association of the cortisol awakening response (CAR) with wake-up cortisol, bedtime cortisol, diurnal slope, and total cortisol area under the curve (AUC). Up to 18 salivary cortisol samples were collected over 3 days from 935 White, Hispanic, and Black individuals (mean age 65 ± 9.8 years) in the Multi-Ethnic Study of Atherosclerosis. Outcome measures included awakening cortisol, CAR (awakening to 30 min post-awakening), early decline (30 min to 2h post-awakening), late decline (2h post-awakening to bedtime), and the corresponding AUCs. Total cortisol AUC was a summary measure of cumulative cortisol exposure. Higher CAR was associated with significantly lower wake-up cortisol (β=-0.56; 95% CI: -0.59 to -0.53) and a higher early decline AUC (β=0.38; 95% CI: 0.34-0.42) but was not associated with total cortisol AUC (β=0.04; 95% CI: -0.01 to 0.09), or other diurnal cortisol curve components following multivariable adjustment. Total cortisol AUC was significantly and positively associated with wake-up cortisol (β=0.36; 95% CI: 0.32-0.40), bedtime cortisol (β=0.61; 95% CI: 0.58-0.64), and other AUC measures, following multivariable adjustment. Associations were similar by sex, race/ethnicity, and age categories. We conclude that bedtime cortisol showed the strongest correlation with total cortisol AUC, suggesting it may be a marker of daily cortisol exposure.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.