Stress, Cortisol, and Lipid Profiles Among Rwandan Undergraduate Students: A Cross-Sectional Study.

Background: Stress negatively affects mental and physical health globally, with university students in sub-Saharan Africa facing unique challenges that exacerbate psychological distress and academic difficulties. Chronic stress contributes to cardiovascular diseases, yet its physiological effects-such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and altered lipid metabolism-remain understudied in this population. There is also a lack of research on the relationship between stress and its physiological impacts among university students in Rwanda. This study aimed to investigate the relationship between serum cortisol levels, lipid profiles, and stress among undergraduate students at the University of Rwanda's Huye Campus. Methods: A cross-sectional study recruited 247 undergraduate students using stratified sampling. Participants completed a researcher-administered Perceived Stress Scale questionnaire and provided sociodemographic data. Fasting blood samples were collected for cortisol and lipid profile analysis, and data was analyzed using Stata version 15. Results: The study included 247 students aged 19-25, with 56.7% males. Stress levels were categorized as low (44.9%), moderate (53.9%), and high (1.2%). Morning cortisol levels (median 13.7µg/dL, IQR 10.8-17.2) did not significantly differ by gender (p > 0.050). However, moderate stress was linked to higher morning cortisol (p < 0.001), total cholesterol (TC), and triglycerides (p = 0.004), with TC also varying significantly across stress levels (p = 0.012). Conclusion: This study found significant associations between stress categories, serum cortisol levels, and lipid profiles, particularly total cholesterol and triglycerides, emphasizing the need for stress management strategies to mitigate long-term health risks.