年长者的DHEA较低与心血管事件有关


  【24drs.com】根据发表于「ENDO 2012:内分泌协会第94届年会」的大型研究,去氢皮质酮(DHEA)值降低的年长者,严重心血管事件比率增加,校正其它传统的心血管风险因素之后依旧如此。
  
  已知DHEA的产生随年纪增加而降低,不过,有关其与心血管健康的研究尚无定论。
  
  为了更了解此关联,瑞典Gothenburg大学的研究者,确认开始时的DHEA值,以及循环时的硫酸酯(DHEA-S)值,对2,416名69-81岁男性进行前瞻研究。
  
  这些男性都参与了「Osteoporotic Fractures in Men Sweden」这项研究,这是一个评估血管疾病风险因素的长期计画。
  
  对瑞典中部的研究对象进行的5年分析、描述心血管方面的临床结果,研究者发现在这5年内有485例致命和非致命的心血管事件。
  
  DHEA-S值最低的四分之一男性显示,严重心血管事件风险比其它三组增加(年纪较正风险比[HR]1.25;95%信心区间[CI] 1.03 - 1.53)。
  
  DHEA和DHEA-S都是最低四分之一的男性,与其它三组相比,任何严重心血管事件(HR,1.34;95% CI,1.06 - 1.70)、冠状心脏病(HR,1.41;95% CI,1.05 - 1.89)以及脑血管事件(HR,1.41;95% CI,1.00 - 1.99)的风险都较高。
  
  即使校正传统的心血管风险因素、以及校正血清睾固酮和雌二醇值之后,此关联依旧显著。
  
  Gothenburg大学副教授Asa Tivesten博士表示,我们观察到年长者之血清DHEA-S值低与后续心血管事件风险增加的关联。这意味著DHEA-S值可提供一些有关心血管风险的信息。一个潜在的实际意义是建立了心血管风险因素,对于DHEA-S值低的男性,应更积极评估与治疗。
  
  不过,这必须有后续研究加以评估。当今,DHEA-S值并未纳入心血管风险评估。
  
  Tivesten博士指出,还未确认DHEA-S之于心血管健康的机转。对于为何DHEA-S有保护力,有一些公认的机制,例如透过抗发炎效果。
  
  不过,我们无法说DHEA-S有保护力,这篇研究并未提供有关因果之信息,例如,我们的研究发现可能是DHEA-S有保护力的结果,也可能是DHEA-S值降低是一般健康状况不佳的标记。
  
  Tivesten博士结论指出,需要更多研究来了解潜在的机转,以及评估荷尔蒙替代治疗的潜在效益。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6868&x_classno=0&x_chkdelpoint=Y
  

Lower DHEA in Elderly Linked to Cardiovascular Events

By Nancy A. Melville
Medscape Medical News

June 27, 2012 (Houston, Texas) — Elderly men with decreased levels of dehydroepiandrosterone (DHEA) show increased rates of major cardiovascular events, even after adjustment for other traditional cardiovascular risk factors, according to a large-scale study presented here at ENDO 2012: The Endocrine Society 94th Annual Meeting.

Production of the naturally occurring steroid DHEA is known to decrease with age; however, studies on its association with cardiovascular health have been inconclusive.

To better evaluate the association, researchers from the University of Gothenburg, Sweden, determined baseline levels of DHEA and its circulating levels as a sulfate ester (DHEA-S) in a prospective, population-based cohort of 2416 men aged 69 to 81 years.

The men were all were participants in the Osteoporotic Fractures in Men Sweden study, a long-term project that is evaluating risk factors for various diseases.

In a 5-year analysis of central Swedish registers describing cardiovascular clinical outcomes, the researchers found there were 485 fatal and nonfatal cardiovascular events during the 5 years.

The men in the lowest quartile of DHEA-S showed an increased risk for major cardiovascular events compared with those in the other quartiles (age-adjusted hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.03 - 1.53).

Those in the lowest quartile of both DHEA and DHEA-S, compared with men in quartiles 2 through 4 of both, showed a higher risk for any major cardiovascular events (HR, 1.34; 95% CI, 1.06 - 1.70), coronary heart disease (HR, 1.41; 95% CI, 1.05 - 1.89), and cerebrovascular events (HR, 1.41; 95% CI, 1.00 - 1.99).

This association was significant even after adjustment for traditional cardiovascular risk factors, as well as adjustment for serum testosterone and estradiol levels.

"We observed an association between low serum levels of DHEA-S and increased risk for future cardiovascular disease events in elderly men," lead author Asa Tivesten, MD, PhD, associate professor at the University of Gothenburg, told Medscape Medical News.

"This means that the DHEA-S level may provide some information about cardiovascular risk. A potential practical implication is that established cardiovascular risk factors should possibly be assessed and treated more aggressively in men with lower DHEA-S levels," said Dr. Tivesten.

"However, this must be evaluated in future studies. Today, DHEA-S level is not part of cardiovascular risk assessment."

Dr. Tivesten noted that the mechanisms behind the role of DHEA-S in cardiovascular health remain uncertain.

"There are some putative mechanisms why DHEA-S could be protective, such as through anti-inflammatory effects," Dr. Tivesten said.

"However, we cannot say that DHEA-S is protective, and the study does not give information about cause and effect. Our findings may, for instance, be the result of DHEA-S being protective, or due to the fact that lower DHEA-S level is a marker for poor general health," he noted.

"More research is needed to understand underlying mechanisms and to evaluate the potential benefits of hormone replacement," Dr. Tivesten concluded.

The study received funding from the following organizations: Swedish Research Council, Swedish Foundation for Strategic Research, Avtal om Lakarutbildning och Forskning research grant in Gothenburg, Swedish Heart-Lung Foundation, Marianne and Marcus Wallenberg Foundation, Lundberg Foundation, Torsten and Ragnar Soderberg/s Foundation, Ake Wiberg Foundation, and Novo Nordisk Foundation. Dr. Tivesten has disclosed no relevant financial relationships.

ENDO 2012: The Endocrine Society 94th Annual Meeting: Abstract OR03-4. Presented June 23, 2012.

    
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