{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T23:52:59Z","timestamp":1793663579099,"version":"4.5.1"},"reference-count":120,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T00:00:00Z","timestamp":1610582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010187","name":"Universiti Sains Islam Malaysia","doi-asserted-by":"publisher","award":["USIM\/FRGS\/FPSK\/055002\/50419"],"award-info":[{"award-number":["USIM\/FRGS\/FPSK\/055002\/50419"]}],"id":[{"id":"10.13039\/501100010187","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The synthesis and secretion of cortisol are controlled by the hypothalamic\u2013pituitary\u2013adrenal 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 \u201ccircadian rhythm and cardiovascular\u201d, \u201ccortisol\u201d, \u201ccortisol and acute coronary syndrome\u201d, \u201ccortisol and arrhythmias\u201d, \u201ccortisol and sudden cardiac death\u201d, \u201ccortisol and stroke\u201d, and \u201ccardioprotective agents\u201d. 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 11\u03b2-hydroxysteroid dehydrogenase (11\u03b2-HSD1), which is a novel molecular target of interest for treating metabolic syndrome and type-2 diabetes mellitus. 11\u03b2-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.<\/jats:p>","DOI":"10.3390\/ijerph18020676","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T11:39:14Z","timestamp":1610624354000},"page":"676","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":213,"title":["Cortisol on Circadian Rhythm and Its Effect on Cardiovascular System"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2070-9215","authenticated-orcid":false,"given":"Nor Amira Syahira","family":"Mohd Azmi","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8660-5593","authenticated-orcid":false,"given":"Norsham","family":"Juliana","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Azmani","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0190-6598","authenticated-orcid":false,"given":"Nadia","family":"Mohd Effendy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6205-001X","authenticated-orcid":false,"given":"Izuddin Fahmy","family":"Abu","sequence":"additional","affiliation":[{"name":"Institute of Medical Science Technology, Universiti Kuala Lumpur, Kajang 43000, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6305-8416","authenticated-orcid":false,"given":"Nur Islami","family":"Mohd Fahmi Teng","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Universiti Teknologi MARA, Bandar Puncak Alam 42300, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srijit","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,14]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Opening the debate: How to fulfill the need for physicians\u2019 training in circadian-related topics in a full medical school curriculum","volume":"13","author":"Selfridge","year":"2015","journal-title":"J. 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