title: Cortisol, DHEA sulphate, their ratio, and all-cause and cause-specific mortality in the Vietnam Experience Study.
abstract: OBJECTIVE
  The aim of the present analyses was to examine the association between cortisol, DHEA sulphate (DHEAS) and the cortisol:DHEAS ratio and mortality.
  
  
  METHODS
  This was a prospective cohort analysis.
  
  
  METHODS
  Participants were 4255 Vietnam-era US army veterans. From military service files, telephone interviews and a medical examination, occupational, socio-demographic and health data were collected. Contemporary morning fasted cortisol and DHEAS concentrations were determined. Mortality was tracked over the subsequent 15 years. The outcomes were all-cause, cardiovascular disease, cancer, other medical mortality and external causes of death. Cox proportional hazard models were tested, initially with adjustment for age, and then with adjustment for a range of candidate confounders.
  
  
  RESULTS
  In general, cortisol concentrations did not show an association with all-cause or cause-specific mortality. However, in age-adjusted and fully adjusted analyses, DHEAS was negatively related to all-cause, all cancers and other medical mortality; high DHEAS concentrations were protective. The cortisol:DHEAS ratio was also associated with these outcomes in both age-adjusted and fully adjusted models; the higher the ratio, the greater the risk of death.
  
  
  CONCLUSIONS
  DHEAS was negatively associated, and the ratio of cortisol to DHEAS was positively associated with all-cause, cancer and other medical cause mortality. Further experimental study is needed to elucidate the mechanisms involved in these relationships.
authors.affiliation: School of Sport and Exercise Sciences, University of Birmingham, Birmingham, England, UK. a.c.phillips@bham.ac.uk
authors.forename: Anna C
authors.initials: AC
authors.lastname: Phillips
authors.forename: Douglas
authors.initials: D
authors.lastname: Carroll
authors.forename: Catharine R
authors.initials: CR
authors.lastname: Gale
authors.forename: Janet M
authors.initials: JM
authors.lastname: Lord
authors.forename: Wiebke
authors.initials: W
authors.lastname: Arlt
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D006304:Health Status; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014728:Veterans; D047829:Vietnam Conflict
chemical_list: D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone