DHEA Levels and Cardiovascular Risk Factors in Women
Clinical Abstracts
With Comments by Adriane Fugh-Berman, MD
DHEA Levels and Cardiovascular Risk Factors in Women
May 2000; Volume 2; 40
Source: Johannes CB, et al. Relation of de-hydroepiandrosterone and dehydroepiandro-sterone sulfate with cardiovascular disease risk factors in women: Longitudinal results from the Massachusetts Women’s Health Study. J Clin Epidemiol 1999;52:95-103.
Design and Setting: A longitudinal study of serum DHEA and DHEAS and cardiovascular disease risk factors in a substudy of the Massachusetts Women’s Health Study.
Subjects: The Massachusetts Women’s Health Study is a random, population-based mailed questionnaire survey of 8,050 middle-aged women. This particular substudy was limited to 236 predominantly Caucasian women who in 1986-1987 were 50-60 years old (mean age 52.7 years) and who had an intact uterus and at least one ovary, with no more than 11 consecutive months of amenorrhea. Each underwent an in-home interview, blood draw, and blood pressure measurement, and then were followed with six more visits (1 year apart except for a three-year gap between visits 3 and 4). Data from HRT users were truncated at the follow-up during which the use was reported.
Outcome Measures: Systolic and diastolic blood pressure, total cholesterol, HDL-cholesterol, apolipoprotein A-1, and apolipoprotein B.
Results: DHEA levels were inversely related to age and positively related to smoking, alcohol use, estrone, and estradiol levels. Multiple regression models for DHEA and each of the cardiovascular disease risk factors found a positive association with systolic (P = 0.003) and diastolic (P = 0.001) blood pressure and a strong inverse relationship between level of DHEAS and apolipoprotein A-1 (P = 0.002).
Funding: National Heart, Lung, and Blood Institute (HL-50482) and the National Institute on Aging (AG-04673).
Comment: DHEA is available over-the-counter and is promoted as an anti-aging supplement for both men and women on the simplistic basis that if a hormone goes down with age, supplementing with that hormone will make one younger. The argument in support of this notion is that epidemiological studies in men have shown an association between higher endogenous serum levels of DHEA and lower rates of cardiovascular disease. There is no evidence that DHEA reduces cardiovascular diseases or cancer risk in women. In fact, some studies have shown that high serum levels of DHEA are associated with an increased rate of cardiovascular disease in women.
Although DHEA can act as a precursor of both androgens and estrogens, DHEA administration clearly increases androgen levels in women at both pharmacologic and physiologic dosing levels. In one study in which women were given 50 mg/d of DHEA (a fairly low dose that results in physiological levels of DHEA), serum androgen levels doubled and there was a slight reduction in high-density lipoprotein levels.1 There are no long-term prospective studies of DHEA supplementation on cardiovascular disease endpoints, but there is no reason to think it is beneficial for women, and the current state of knowledge raises the question that supplementation may be deleterious to women. Also, studying endogenous DHEA levels in unsupplemented women may have nothing to do with predicting the consequences of supplementation. Caution is warranted.
References
1. Morales AJ et al. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab 1994;78:1360-1367.
May 2000; Volume 2; 40
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