title: Higher Estradiol and Lower Dehydroepiandrosterone-Sulfate Levels Are Associated with Pulmonary Arterial Hypertension in Men.
abstract: Recent studies have focused on the role of female sex and estradiol (E2) in pulmonary arterial hypertension (PAH), but it is not known whether sex hormones are risk factors for PAH in men.
  
  
  
  We performed a case-control study to determine whether hormone levels (E2, dehydroepiandrosterone-sulfate [DHEA-S], and testosterone) are associated with PAH in men.
  
  
  
  Plasma sex hormone levels in men with idiopathic, heritable, or connective tissue disease-associated PAH were compared with those from age- and body mass index-matched men without clinical cardiovascular disease.
  
  
  
  There were 23 cases with PAH (70% had idiopathic PAH, 65% were functional class III/IV) and 67 control subjects. Higher E2 and E2/testosterone levels were associated with the risk of PAH (odds ratio per 1 ln[E2:testosterone], 6.0; 95% confidence interval, 2.2-16.4; P = 0.001), whereas higher levels of DHEA-S were associated with a reduced risk (odds ratio per 1 ln[DHEA-S], 0.1; 95% confidence interval, 0.0-0.3; P = 0.001). E2 and DHEA-S levels were strong predictors of case status (C statistic for both, 0.82) but testosterone was not (C statistic, 0.53). Higher levels of E2 were associated with shorter 6-minute-walk distances (P = 0.03), whereas higher levels of DHEA-S were associated with lower right atrial pressure (P = 0.02) and pulmonary vascular resistance (P = 0.01) in men with PAH.
  
  
  
  Higher levels of E2 and lower levels of DHEA-S were associated with PAH in men. Sex-based differences in sex hormone processing and signaling may contribute to unique phenotypes in pulmonary vascular disease.
authors.affiliation: 1 Department of Medicine and.|2 Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, Rhode Island.|3 Lifespan Hospital System, Providence, Rhode Island.
authors.forename: Corey E
authors.identifier: 0000-0002-4223-4775
authors.initials: CE
authors.lastname: Ventetuolo
authors.affiliation: 3 Lifespan Hospital System, Providence, Rhode Island.
authors.forename: Grayson L
authors.initials: GL
authors.lastname: Baird
authors.affiliation: 4 Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
authors.affiliation: 5 Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute for Biomedical Imaging and Bioengineering, Bethesda, Maryland.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: 6 Department of Medicine.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Fritz
authors.affiliation: 7 Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; and.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Hill
authors.affiliation: 1 Department of Medicine and.|3 Lifespan Hospital System, Providence, Rhode Island.
authors.forename: James R
authors.initials: JR
authors.lastname: Klinger
authors.affiliation: 8 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: 8 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Pamela
authors.initials: P
authors.lastname: Ouyang
authors.affiliation: 6 Department of Medicine.
authors.forename: Harold I
authors.initials: HI
authors.lastname: Palevsky
authors.affiliation: 3 Lifespan Hospital System, Providence, Rhode Island.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Palmisciano
authors.affiliation: 3 Lifespan Hospital System, Providence, Rhode Island.
authors.forename: Ipsita
authors.initials: I
authors.lastname: Krishnan
authors.affiliation: 6 Department of Medicine.
authors.forename: Diane
authors.initials: D
authors.lastname: Pinder
authors.affiliation: 7 Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; and.
authors.forename: Ioana R
authors.initials: IR
authors.lastname: Preston
authors.affiliation: 7 Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; and.
authors.forename: Kari E
authors.initials: KE
authors.lastname: Roberts
authors.affiliation: 6 Department of Medicine.|9 Center for Clinical Epidemiology and Biostatistics, and.|10 Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D004958:Estradiol / Q000097:blood*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate
keywords: DHEA; estradiol; pulmonary hypertension; sex hormones