DHEA predicts coronary heart disease risk
DHEA (dehydroepiandosterone) an adrenal steroid hormone also produced in the brain, is associated with many inflammatory and other disorders. A study recently published in the Journal of the American College of Cardiology shows that low DHEA can predict coronary heart disease in older men. This is especially important because there is still a high incidence of sudden cardiac death in individuals who do not have the traditional risk factors. The authors state:
"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."
To test predictive value for major coronary heart disease (CHD) and/or cerebrovascular disease (CBD) events, they measured baseline levels in a large cohort of men aged 69-81 and correlated this with a 5-year follow-up for complete cardiovascular clinical outcomes.
DHEA predicts coronary heart disease but not stroke
The predictive accuracy persisted even when traditional cardiovascular risk factors were adjusted for :
"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."
Changing the assessment of cardiovascular risk
The authors of an editorial in the same issue of JACC assert:
"Everything we once thought we knew about the therapeutic use of estrogen for the prevention of cardiovascular disease (CVD) in women is wrong. Everything we once knew about the role of sex in CVD is still right; men are affected a decade earlier than women. We are still enamored with the idea that sex steroids, particularly androgens, have, if not a causal role in CVD development, at least an association. We simply cannot get the notion out of our heads that androgens (or relative lack of estrogen) drive endothelial dysfunction and atherogenesis, and potentially, even plaque fracture. In this light, new studies that assess the risk associated with low levels of a particularly abundant sex steroid (dehydroepiandrosterone [DHEA] and its sulfated congener [DHEA-S], which can serve as the precursor substrate for either testosterone or estradiol) are of particular interest."
They note an important difference between the two forms:
"Furthermore, this study measured both DHEA and DHEA-S, and showed a more pronounced negative relationship between mortality and DHEA than that with DHEA-S. This suggests that DHEA could be a more important predictor of outcomes, despite low plasma DHEA concentrations relative to DHEA-S. This has significant implications, because most previous negative studies examined only DHEA-S levels."
A new arrow in the quiver
Cardiovascular disease is complex and multi-causal...
"Despite advances in primary and secondary prevention of CHD events, there is still a high incidence of death due to CHD, including sudden cardiac death in individuals who do not have traditional coronary disease risk factors...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. DHEA may represent a new arrow in the quiver of biomarkers...The findings reported here should, at the least, spur further interest in understanding DHEA as a biomarker of CVD risk."
Clinical Note
It is, of course, never desirable to recommend or take any hormone, OTC or not, without measuring free-fraction hormone levels comprehensively at baseline and after appropriate intervals. Clinicians, however, can add DHEA levels to CHD risk assessment in older men.The authors conclude:
"Low serum levels of DHEA and its sulfate predict an increased risk of CHD, but not CBD, events in elderly men."