DHEA-S levels and cardiovascular disease mortality in postmenopausal women: Results from the National Institutes of Health - National Heart, Lung, and Blood Institute (NHLBI)-Sponsored Women's Ischemia Syndrome Evaluation (WISE)

Chrisandra Shufelt, Philip Bretsky, Cristina M. Almeida, B. Delia Johnson, Leslee J. Shaw, Ricardo Azziz, Glenn D. Braunstein, Carl J. Pepine, Vera Bittner, Diane A. Vido, Frank Z. Stanczyk, C. Noel Bairey Merz

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)4985-4992
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume95
Issue number11
DOIs
StatePublished - Nov 2010

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National Heart, Lung, and Blood Institute (U.S.)
Dehydroepiandrosterone Sulfate
National Institutes of Health (U.S.)
Blood
Cardiovascular Diseases
Ischemia
Health
Mortality
Coronary Artery Disease
Hazards
Angiography
Confidence Intervals
Coronary Angiography
Myocardial Ischemia
Heart Failure
Stroke
Odds Ratio
Steroids
Myocardial Infarction

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

DHEA-S levels and cardiovascular disease mortality in postmenopausal women : Results from the National Institutes of Health - National Heart, Lung, and Blood Institute (NHLBI)-Sponsored Women's Ischemia Syndrome Evaluation (WISE). / Shufelt, Chrisandra; Bretsky, Philip; Almeida, Cristina M.; Johnson, B. Delia; Shaw, Leslee J.; Azziz, Ricardo; Braunstein, Glenn D.; Pepine, Carl J.; Bittner, Vera; Vido, Diane A.; Stanczyk, Frank Z.; Merz, C. Noel Bairey.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 95, No. 11, 11.2010, p. 4985-4992.

Research output: Contribution to journalArticle

Shufelt, Chrisandra ; Bretsky, Philip ; Almeida, Cristina M. ; Johnson, B. Delia ; Shaw, Leslee J. ; Azziz, Ricardo ; Braunstein, Glenn D. ; Pepine, Carl J. ; Bittner, Vera ; Vido, Diane A. ; Stanczyk, Frank Z. ; Merz, C. Noel Bairey. / DHEA-S levels and cardiovascular disease mortality in postmenopausal women : Results from the National Institutes of Health - National Heart, Lung, and Blood Institute (NHLBI)-Sponsored Women's Ischemia Syndrome Evaluation (WISE). In: Journal of Clinical Endocrinology and Metabolism. 2010 ; Vol. 95, No. 11. pp. 4985-4992.
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abstract = "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.",
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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

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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.

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