Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Centre for Bone and Arthritis Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
J Am Coll Cardiol. 2014 Oct 28;64(17):1801-10. doi: 10.1016/j.jacc.2014.05.076. Epub 2014 Oct 21.
The adrenal sex hormone dehydroepiandrosterone (DHEA), which is present in serum mainly as the sulfate DHEA-S, is the most abundant steroid hormone in human blood. Its levels decline dramatically with age. Despite the great amount of literature on vascular and metabolic actions of DHEA/-S, evidence for an association between DHEA/-S levels and cardiovascular events is contradictory.
This study tested the hypothesis that serum DHEA and DHEA-S are predictors of major coronary heart disease (CHD) and/or cerebrovascular disease (CBD) events in a large cohort of elderly men.
We used gas and liquid chromatography-mass spectrometry to analyze baseline levels of DHEA and DHEA-S in the prospective population-based Osteoporotic Fractures in Men study in Sweden (2,416 men, ages 69 to 81 years). Complete cardiovascular clinical outcomes were available from national Swedish registers.
During the 5-year follow-up, 302 participants experienced a CHD event, and 225 had a CBD event. Both DHEA and DHEA-S levels were inversely associated with the age-adjusted risk of a CHD event; the hazard ratios and 95% confidence intervals per SD increase were 0.82 (0.73 to 0.93) and 0.86 (0.77 to 0.97), respectively. In contrast, DHEA/-S showed no statistically significant association with the risk of CBD events. The association between DHEA and CHD risk remained significant after adjustment for traditional cardiovascular risk factors, serum total testosterone and estradiol, C-reactive protein, and renal function, and remained unchanged after exclusion of the first 2.6 years of follow-up to reduce reverse causality.
Low serum levels of DHEA and its sulfate predict an increased risk of CHD, but not CBD, events in elderly men.
肾上腺性激素脱氢表雄酮（DHEA），主要以硫酸酯形式 DHEA-S 存在于血清中，是人体血液中最丰富的类固醇激素。其水平随年龄的增长而显著下降。尽管有大量关于 DHEA/-S 的血管和代谢作用的文献，但 DHEA/-S 水平与心血管事件之间的关联证据仍存在争议。
本研究旨在检验血清 DHEA 和 DHEA-S 是否可预测老年男性中主要冠心病（CHD）和/或脑血管疾病（CBD）事件的假说。
我们使用气相和液相色谱-质谱联用技术分析了瑞典骨质疏松性骨折男性研究（2416 名年龄在 69 至 81 岁的男性）前瞻性人群中的基线 DHEA 和 DHEA-S 水平。完整的心血管临床结局可从瑞典国家登记处获得。
在 5 年的随访期间，302 名参与者发生了 CHD 事件，225 名参与者发生了 CBD 事件。DHEA 和 DHEA-S 水平均与 CHD 事件的年龄调整风险呈负相关；每增加一个标准差，风险比和 95%置信区间分别为 0.82（0.73 至 0.93）和 0.86（0.77 至 0.97）。相反，DHEA/-S 与 CBD 事件的风险无统计学显著关联。在调整传统心血管危险因素、血清总睾酮和雌二醇、C 反应蛋白和肾功能后，DHEA 与 CHD 风险的关联仍然显著，并且在排除前 2.6 年随访以减少反向因果关系后，该关联保持不变。
血清 DHEA 及其硫酸盐水平低可预测老年男性 CHD 事件风险增加，但不能预测 CBD 事件风险。
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