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Adrenal androgens and testosterone as coronary risk factors in the Helsinki Heart Study
A Hautanen1, M Mänttäri, V Manninen
1Department of Clinical Chemistry, University of Helsinki, Finland.
Insights
Higher dehydroepiandrosterone sulfate (DHEAS) levels are linked to increased coronary heart disease (CHD) risk, particularly in older men and smokers. This suggests a potential role for adrenal function in cardiovascular health.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Epidemiology
Background:
- Adrenal androgens, cortisol, testosterone, and sex-hormone binding globulin (SHBG) are implicated in cardiovascular health.
- Understanding their role as coronary risk factors is crucial for preventative strategies.
Purpose of the Study:
- To investigate the association between adrenal androgens and other hormones with coronary heart disease (CHD) risk.
- To determine if dehydroepiandrosterone sulfate (DHEAS) is an independent risk factor for cardiac events.
Main Methods:
- Nested case-control study within the Helsinki Heart Study (62 cases, 97 controls).
- Radioimmunoassays used to measure serum concentrations of dehydroepiandrosterone, DHEAS, androstenedione, androstanediol glucuronide, cortisol, testosterone, and SHBG.
- Logistic regression analyses adjusted for classical CHD risk factors.
Main Results:
- Cases with cardiac end-points had significantly higher DHEAS levels than controls (P < 0.04).
- DHEAS levels positively correlated with smoking, alcohol consumption, triglycerides, systolic and diastolic blood pressures.
- DHEAS levels negatively correlated with age and HDL-cholesterol.
- Elevated DHEAS significantly increased CHD risk in older men (OR 7.3) and smokers (OR 3.4).
Conclusions:
- Higher serum DHEAS levels are associated with an increased risk of coronary heart disease.
- This association is particularly pronounced in older men and smokers.
- Potential mechanisms include adrenal steroid biosynthetic defects or functional adrenal hyperplasia.
Abstract:
We investigated the role of adrenal androgens, cortisol, testosterone and sex-hormone binding globulin (SHBG) as coronary risk factors using a nested case-control design. The study population consisted of 62 cases with cardiac end-points and 97 controls on placebo during the last 4 years in the Helsinki Heart Study. Serum concentrations of dehydroepiandrosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, androstanediol glucuronide, cortisol, testosterone, and SHBG at the first annual visit of the 5-year study period were determined by radioimmunoassays. The only significant difference was found in DHEAS, with cases having higher levels than controls (P < 0.04). DHEAS levels were positively associated with smoking (P < 0.001), alcohol consumption (P < 0.04) and triglyceride levels (P < 0.002) and with systolic (P < 0.04) and diastolic (P < 0.006) blood pressures, and negatively associated with age (P < 0.01) and HDL-cholesterol (P < 0.03). The association between DHEAS and the CHD risk was studied using logistic regression analyses with the classical risk factors--age, smoking, blood pressure, and lipid levels--as covariates in the models. Studies of the joint effects of age and DHEAS disclosed that the risk associated with elevated DHEAS was confirmed to older men (odds ratio (OR) 7.3, 95%, CI 2.3-23.3). A similar analysis with smoking revealed that the DHEAS-related risk was mainly found in smokers (OR 3.4, 95% CI 1.5-8.2). One possible explanation for these results is that some form of mild steroid biosynthetic defect of the adrenals or functional adrenal hyperplasia associated with high DHEAS levels increases the CHD risk in this population.