Lower DHEA in Elderly Linked to Cardiovascular Events

Nancy A. Melville

June 27, 2012

June 27, 2012 (Houston, Texas) — Elderly men with decreased levels of dehydroepiandrosterone (DHEA) show increased rates of major cardiovascular events, even after adjustment for other traditional cardiovascular risk factors, according to a large-scale study presented here at ENDO 2012: The Endocrine Society 94th Annual Meeting.

Production of the naturally occurring steroid DHEA is known to decrease with age; however, studies on its association with cardiovascular health have been inconclusive.

To better evaluate the association, researchers from the University of Gothenburg, Sweden, determined baseline levels of DHEA and its circulating levels as a sulfate ester (DHEA-S) in a prospective, population-based cohort of 2416 men aged 69 to 81 years.

The men were all were participants in the Osteoporotic Fractures in Men Sweden study, a long-term project that is evaluating risk factors for various diseases.

In a 5-year analysis of central Swedish registers describing cardiovascular clinical outcomes, the researchers found there were 485 fatal and nonfatal cardiovascular events during the 5 years.

The men in the lowest quartile of DHEA-S showed an increased risk for major cardiovascular events compared with those in the other quartiles (age-adjusted hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.03 - 1.53).

Those in the lowest quartile of both DHEA and DHEA-S, compared with men in quartiles 2 through 4 of both, showed a higher risk for any major cardiovascular events (HR, 1.34; 95% CI, 1.06 - 1.70), coronary heart disease (HR, 1.41; 95% CI, 1.05 - 1.89), and cerebrovascular events (HR, 1.41; 95% CI, 1.00 - 1.99).

This association was significant even after adjustment for traditional cardiovascular risk factors, as well as adjustment for serum testosterone and estradiol levels.

"We observed an association between low serum levels of DHEA-S and increased risk for future cardiovascular disease events in elderly men," lead author Asa Tivesten, MD, PhD, associate professor at the University of Gothenburg, told Medscape Medical News.

"This means that the DHEA-S level may provide some information about cardiovascular risk. A potential practical implication is that established cardiovascular risk factors should possibly be assessed and treated more aggressively in men with lower DHEA-S levels," said Dr. Tivesten.

"However, this must be evaluated in future studies. Today, DHEA-S level is not part of cardiovascular risk assessment."

Dr. Tivesten noted that the mechanisms behind the role of DHEA-S in cardiovascular health remain uncertain.

"There are some putative mechanisms why DHEA-S could be protective, such as through anti-inflammatory effects," Dr. Tivesten said.

"However, we cannot say that DHEA-S is protective, and the study does not give information about cause and effect. Our findings may, for instance, be the result of DHEA-S being protective, or due to the fact that lower DHEA-S level is a marker for poor general health," he noted.

"More research is needed to understand underlying mechanisms and to evaluate the potential benefits of hormone replacement," Dr. Tivesten concluded.

The study received funding from the following organizations: Swedish Research Council, Swedish Foundation for Strategic Research, Avtal om Lakarutbildning och Forskning research grant in Gothenburg, Swedish Heart-Lung Foundation, Marianne and Marcus Wallenberg Foundation, Lundberg Foundation, Torsten and Ragnar Soderberg/s Foundation, Ake Wiberg Foundation, and Novo Nordisk Foundation. Dr. Tivesten has disclosed no relevant financial relationships.

ENDO 2012: The Endocrine Society 94th Annual Meeting: Abstract OR03-4. Presented June 23, 2012.