Cardiovascular Disease Is Associated with Greater Incident Dehydroepiandrosterone Sulfate Decline in the Oldest Old: The Cardiovascular Health Study All Stars Study

Abstract

OBJECTIVES-To describe cross-sectional and longitudinal associations with dehydroepiandrosterone sulfate (DHEAS) and change in DHEAS with age. DESIGN-Longitudinal cohort study.SETTING-Pittsburgh, Pennsylvania. PARTICIPANTS-CardiovascularHealth Study All Stars study participants assessed in 2005/06 (N =989, mean age 85.2, 63.5% women, 16.5% African American).Address correspondence to Jason Sanders, 4614 Fifth Ave, Apt 217, Pittsburgh, PA 15213. sanders.jason@medstudent.pitt.edu. The work from which this manuscript was derived appeared as an abstract at the 2009 American Geriatrics Society Annual Meeting, Chicago, Illinois, April 29-May 2, where it won the Presidential Poster Award in the epidemiology category. Conflict of Interest:The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Financial Disclosure: The research reported in this article was supported by National Institute on Aging (NIA) Grant AG-023629. CHS was supported by Contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, and N01-HC-45133 and Grant U01 HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by NIA Grants R01 AG-15928, R01 AG-20098, and AG-027058 , DHEAS was lower in women and subjects with cardiovascular disease (CVD) and chronic pulmonary disease and higher for African Americans and subjects with hypertension and high cholesterol. Mean DHEAS change was greater in men (− 0.200 μg/mL) than in women (− 0.078 μg/mL) (P<.001). Each 1-year increase in age attenuated the effect of male sex by 0.01 μg/mL (P =.009), abolishing the sex difference in DHEAS change by age 79. Presence of CVD before the study period was associated with greater absolute DHEAS change (β = − 0.04 μg/ mL, P =.04) and with the fourth quartile of DHEAS change versus the first to third quartiles (odds ratio =1.46, 95% confidence interval =1.03-2.05). Previous studies have investigated the outcomes that DHEAS predicts and sought to define its association with mortality independent of age. Data supportive of this are conflicting. 4 Earlier studies reported no association with mortality in women, whereas later studies indicated that higher DHEAS is associated with lower all-cause mortality and cardiovascular-specific mortality in men. 4 More-recent reports indicate that low DHEAS is associated with greater mortality in men and women. [5][6][7] One study found that low and high DHEAS each confer greater mortality in disabled older women (U-shaped association) and that the slope and variability of DHEAS change, rather than baseline DHEAS level, is associated with greater mortality. 8,9 These reports suggest that a disordered neuro-endocrine axis or altered homeostasis increases mortality rather than a unidirectional shift in hormone levels...

Influence of adrenal hyperandrogenism on the clinical and metabolic phenotype of women with polycystic ovary syndrome

“…Besides the higher insulin resistance of AH-PCOS women, the intriguing relationship found between the lipid profiles and AH of our patients may support the proposed protective effect of DHEAS against cardiovascular diseases (40)(41)(42), especially in obese patients. Although we observed decreased HDL cholesterol levels in nonobese AH-PCOS women, there was also a near significant decrease in TC concentrations, explaining why the TC to HDL cholesterol ratio-the most effective lipid screening method to estimate cardiovascular risk (43)-remained unchanged.…”

Socioeconomic Status and Poor Health Outcome at 10 Years of Follow-Up in the Multi-Ethnic Study of Atherosclerosis

“…The Cardiovascular Health Study (CHS) All Stars Study conducted an examination in 2005–06 of CHS participants aged 77 years and older that included measure of cognitive and physical function [33]. Several publications from CHS All Stars are relevant [34,35,36,37,38,39,40] but none specifically addressed the predictors of reaching older age in good physical, cognitive, and psychological health.…”

Genetic and environmental effects on diurnal dehydroepiandrosterone sulfate concentrations in middle-aged men

“…Additionally, evaluation of diurnal regulation of DHEAS across development may also be an important risk factor for disease. Prior studies of DHEAS across the lifespan indicated that lifetime trajectories of DHEAS concentrations, rather than baseline DHEAS concentrations alone were associated with higher mortality in older adults (Cappola, A. R. et al, 2009) as well as cardiovascular disease (Sanders, J. L. et al, 2010). Consequently, these results encourage the characterization diurnal DHEAS profiles and the estimation of genetic and environmental contributions to profiles across the lifespan.…”