TY - JOUR
T1 - DHEA-S levels and cardiovascular disease mortality in postmenopausal women
T2 - Results from the National Institutes of Health - National Heart, Lung, and Blood Institute (NHLBI)-Sponsored Women's Ischemia Syndrome Evaluation (WISE)
AU - Shufelt, Chrisandra
AU - Bretsky, Philip
AU - Almeida, Cristina M.
AU - Johnson, B. Delia
AU - Shaw, Leslee J.
AU - Azziz, Ricardo
AU - Braunstein, Glenn D.
AU - Pepine, Carl J.
AU - Bittner, Vera
AU - Vido, Diane A.
AU - Stanczyk, Frank Z.
AU - Merz, C. Noel Bairey
N1 - Funding Information:
This work was supported by contracts from the National Heart, Lung, and Blood Institute , nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164 , a GCRC Grant MO1-RR00425 from the National Center for Research Resources , and grants from the Gustavus and Louis Pfeiffer Research Foundation (Denville, NJ), The Women's Guild of Cedars-Sinai Medical Center (Los Angeles, CA), The Ladies Hospital Aid Society of Western Pennsylvania (Pittsburgh, PA), the Edythe L. Broad Endowment, Cedars-Sinai Medical Center (Los Angeles, CA), and the Barbra Streisand Women's Cardiovascular Disease Research and Education Program, Cedars-Sinai Medical Center.
PY - 2010/11
Y1 - 2010/11
N2 - Context: Dehydroepiandrosterone sulfate (DHEA-S), a major circulating sex steroid prohormone, declines with age. Low levels have been associated with increased cardiovascular disease (CVD) risk and all-cause mortality, although these results have not been consistently replicated, particularly in women. Objective: Our objective was to examine the association of circulating DHEA-S levels, CVD, and mortality risk among postmenopausal women with suspected myocardial ischemia. Design: In the Women's Ischemia Syndrome Evaluation, 270 postmenopausal women underwent coronary angiography and blood hormone levels for suspected ischemia and were followed annually. The primary outcome of interest was CVD mortality; secondary analyses included all-cause mortality and nonfatal CVD events (myocardial infarction, stroke, and congestive heart failure) and angiographic obstructive coronary artery disease (CAD). Results: Women in the lowest DHEA-S tertile had higher CVD mortality (17% 6-yr mortality rate vs. 8%; log-rank P = 0.011), and all-cause mortality (21 vs. 10%; P = 0.011) compared with women with higher DHEA-S levels. The increased CVD mortality risk [hazard ratio (HR) = 2.55; 95% confidence interval (CI) = 1.19-5.45] remained unchanged after adjustment for multiple CVD risk factors (HR = 2.43; 95% CI = 1.06-5.56) but became nonsignificant when further adjusting for the presence or severity of angiographic obstructive CAD (HR = 1.99; 95% CI = 0.87-4.59). Results were similar for all-cause mortality. Lower DHEA-S levels were only marginally but not independently associated with obstructive CAD. Conclusions: Among postmenopausal women with coronary risk factors undergoing coronary angiography for suspected myocardial ischemia, lower DHEA-S levels were linked with higher CVD mortality and all-cause mortality. Our study provides valuable feasibility data useful for future investigations and possible mechanistic pathways.
AB - Context: Dehydroepiandrosterone sulfate (DHEA-S), a major circulating sex steroid prohormone, declines with age. Low levels have been associated with increased cardiovascular disease (CVD) risk and all-cause mortality, although these results have not been consistently replicated, particularly in women. Objective: Our objective was to examine the association of circulating DHEA-S levels, CVD, and mortality risk among postmenopausal women with suspected myocardial ischemia. Design: In the Women's Ischemia Syndrome Evaluation, 270 postmenopausal women underwent coronary angiography and blood hormone levels for suspected ischemia and were followed annually. The primary outcome of interest was CVD mortality; secondary analyses included all-cause mortality and nonfatal CVD events (myocardial infarction, stroke, and congestive heart failure) and angiographic obstructive coronary artery disease (CAD). Results: Women in the lowest DHEA-S tertile had higher CVD mortality (17% 6-yr mortality rate vs. 8%; log-rank P = 0.011), and all-cause mortality (21 vs. 10%; P = 0.011) compared with women with higher DHEA-S levels. The increased CVD mortality risk [hazard ratio (HR) = 2.55; 95% confidence interval (CI) = 1.19-5.45] remained unchanged after adjustment for multiple CVD risk factors (HR = 2.43; 95% CI = 1.06-5.56) but became nonsignificant when further adjusting for the presence or severity of angiographic obstructive CAD (HR = 1.99; 95% CI = 0.87-4.59). Results were similar for all-cause mortality. Lower DHEA-S levels were only marginally but not independently associated with obstructive CAD. Conclusions: Among postmenopausal women with coronary risk factors undergoing coronary angiography for suspected myocardial ischemia, lower DHEA-S levels were linked with higher CVD mortality and all-cause mortality. Our study provides valuable feasibility data useful for future investigations and possible mechanistic pathways.
UR - http://www.scopus.com/inward/record.url?scp=78049520519&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78049520519&partnerID=8YFLogxK
U2 - 10.1210/jc.2010-0143
DO - 10.1210/jc.2010-0143
M3 - Article
C2 - 20739385
AN - SCOPUS:78049520519
SN - 0021-972X
VL - 95
SP - 4985
EP - 4992
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 11
ER -
