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).
BACKGROUND
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.


METHODS
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.
Shufelt
Chrisandra
C
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Bretsky
Philip
P
Almeida
Cristina M
CM
Johnson
B Delia
BD
Shaw
Leslee J
LJ
Azziz
Ricardo
R
Braunstein
Glenn D
GD
Pepine
Carl J
CJ
Bittner
Vera
V
Vido
Diane A
DA
Stanczyk
Frank Z
FZ
Bairey Merz
C Noel
CN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality*; D002423:Cause of Death; D017023:Coronary Angiography; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D006801:Humans; D007118:Immunoassay; D008875:Middle Aged; D017698:Postmenopause / Q000097:blood*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States
D019314:Dehydroepiandrosterone Sulfate