Low levels of DHEA predicted CHD risk in elderly men

Low serum levels of the adrenal sex hormone dehydroepiandrosterone and its sulfate were predictors of increased risk for CHD events in elderly men, researchers found.

However, serum levels of dehydroepiandrosterone (DHEA) and its sulfate did not predict risk for cerebrovascular events in older men, according to the researchers.

Although levels of DHEA and its sulfate decline with age, and much is known about related vascular and metabolic actions, the association between DHEA and its sulfate with CV events was not known, according to the study background.

Åsa Tivesten, MD, PhD, from the Wallenberg Laboratory for Cardiovascular and Metabolic Research of the Institute of Medicine at the University of Gothenburg, Sweden, and colleagues conducted a study to analyze the levels of DHEA and its sulfate. The study included 2,416 men aged 69 to 81 years at baseline in the Osteoporotic Fractures in Men study. Participants were followed for 5 years, and CV clinical outcomes were obtained from national Swedish registers. The primary outcome was CHD or cerebrovascular disease event.

During the study period, a CHD event was reported in 302 participants and a cerebrovascular disease event in 225 participants.

The researchers reported an inverse relationship between levels of DHEA and its sulfate with the age-adjusted risk for a CHD event (DHEA, HR per 1 standard deviation increase=0.82; 95% CI, 0.73-0.93; DHEA sulfate, HR per 1 standard deviation increase=0.86; 95% CI, 0.77-0.97).

However, they found no association between levels of DHEA or its sulfate and increased risk for cerebrovascular events (DHEA, HR per 1 standard deviation increase=0.91; 95% CI, 0.79-1.04; DHEA sulfate, HR per 1 standard deviation increase=0.9; 95% CI, 0.79-1.02).

Adjustment for traditional CV risk factors, serum total testosterone and estradiol, C-reactive protein and renal function did not change the results, nor did excluding the first 2.6 years of follow-up to reduce the chance of reverse causality, according to the researchers.

In a related editorial, Nadia R. Sutton, MD, MPH, and David J. Pinsky. MD, wrote that the results “showed a more pronounced negative relationship between mortality and DHEA than that with DHEA [sulfate]. This suggests that DHEA could be a more important predictor of outcomes, despite low plasma DHEA concentrations relative to DHEA [sulfate].” This may shed some light on previous negative studies that compared only DHEA sulfate with CV outcomes, they wrote.

“An ideal solution might be the use of weighted patterns of biomarkers, which would take into consideration typical biochemical interactions and provide a personalized biochemical fingerprint to more exactly define an individual’s risk of future events,” wrote Sutton and Pinsky, both from the division of cardiovascular medicine of the Samuel and Jean Frankel Cardiovascular Center at University of Michigan. “DHEA may represent a new arrow in the quiver of biomarkers.”

For more information:

Sutton NR. J Am Coll Cardiol. 2014;64:1811-1813.

Tivesten A. J Am Coll Cardiol. 2014;64:1801-1810.

Disclosure: See the full study for a list of funding sources. The researchers, Pinksy and Sutton report no relevant financial disclosures.