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Dehydroepiandrosterone: the "missing link" between hyperinsulinemia and atherosclerosis?
J E Nestler1, J N Clore, W G Blackard
1Department of Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond 23298.
Summary
High insulin levels (hyperinsulinemia) may lead to artery damage (atherogenesis) by lowering levels of the adrenal steroid dehydroepiandrosterone (DHEA). This may explain links between hyperinsulinemia and cardiovascular disease in aging and obesity.
Area of Science:
- Endocrinology
- Cardiovascular Science
- Metabolic Disease
Background:
- Hyperinsulinemia is linked to macrovascular disease, but the underlying mechanisms remain unclear.
- Dehydroepiandrosterone (DHEA) is an adrenal steroid with known antiatherogenic properties.
- Emerging evidence suggests hyperinsulinemia might lower DHEA and DHEA-sulfate levels.
Purpose of the Study:
- To investigate the hypothesis that hyperinsulinemia promotes atherogenesis by reducing serum DHEA and DHEA-sulfate.
- To explore this mechanism in the context of aging and obesity, conditions associated with hyperinsulinemic insulin resistance.
Main Methods:
- The study proposes a hypothesis based on existing evidence.
- It illustrates the proposed mechanism through clinical conditions like aging and obesity.
- No new experimental data was generated; this is a theoretical/hypothesis-driven review.
Main Results:
- Hyperinsulinemia may reduce serum DHEA and DHEA-sulfate by inhibiting production and increasing clearance.
- This reduction in DHEA/DHEA-sulfate is proposed as a key factor in hyperinsulinemia-driven atherogenesis.
- The hypothesis is illustrated in aging and obesity, characterized by hyperinsulinemic insulin resistance.
Conclusions:
- Hyperinsulinemia may promote macrovascular disease partly through the reduction of serum DHEA and DHEA-sulfate levels.
- This hormonal imbalance could be a significant contributor to atherogenesis in conditions of insulin resistance.
- Further research is warranted to validate this proposed mechanism and its clinical implications.