Relationship between insulin sensitivity and dehydroepiandrosterone sulfate in patients with ischemic heart disease

Insulin resistance has been related to the pathogenesis and development of ischemic heart disease (IHD). Dehydroepiandrosterone sulfate (DHEA-S) has been suggested as the possible link between these two entities. The aim of this study was to clarify the relationship between insulin resistance and DHEA-S in patients with IHD. Thirty-two male patients with newly-diagnosed IHD and without known metabolic disorders and 11 healthy matched controls were included in this study. Insulin sensitivity was assessed by an insulin suppression test, and DHEA-S levels were measured before the test (basal) and at the end of the test (during hyperinsulinemia). Insulin resistance, defined as an insulin sensitivity index (ISI) below the normal range derived from the control group, was present in 78% of IHD patients; they also displayed, as a group, lower ISI (P < 0.0001) than controls. DHEA-S levels were lower in IHD than in controls, both basal and during hyperinsulinemia (P < 0.05). DHEA-S levels decreased when hyperinsulinemia was achieved, both in IHD patients and controls (P < 0.0005). The magnitude of the decrease was the same in both groups. No correlation between ISI and DHEA-S levels was found. In conclusion, insulin sensitivity is lower in patients with IHD, even when major metabolic abnormalities associated with insulin resistance are excluded. These patients also show decreased DHEA-S levels, which are further reduced when acute induced hyperinsulinemia is achieved, although, as the decline was similar to that of controls, there does not seem to be resistance to this particular action of insulin.