年長者的DHEA較低與心血管事件有關


  【24drs.com】根據發表於「ENDO 2012:內分泌協會第94屆年會」的大型研究,去氫皮質酮(DHEA)值降低的年長者,嚴重心血管事件比率增加,校正其他傳統的心血管風險因素之後依舊如此。
  
  已知DHEA的產生隨年紀增加而降低,不過,有關其與心血管健康的研究尚無定論。
  
  為了更暸解此關聯,瑞典Gothenburg大學的研究者,確認開始時的DHEA值,以及循環時的硫酸酯(DHEA-S)值,對2,416名69-81歲男性進行前瞻研究。
  
  這些男性都參與了「Osteoporotic Fractures in Men Sweden」這項研究,這是一個評估血管疾病風險因素的長期計畫。
  
  對瑞典中部的研究對象進行的5年分析、描述心血管方面的臨床結果,研究者發現在這5年內有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顯示,嚴重心血管事件風險比其他三組增加(年紀較正風險比[HR]1.25;95%信心區間[CI] 1.03 - 1.53)。
  
  DHEA和DHEA-S都是最低四分之一的男性,與其他三組相比,任何嚴重心血管事件(HR,1.34;95% CI,1.06 - 1.70)、冠狀心臟病(HR,1.41;95% CI,1.05 - 1.89)以及腦血管事件(HR,1.41;95% CI,1.00 - 1.99)的風險都較高。
  
  即使校正傳統的心血管風險因素、以及校正血清睪固酮和雌二醇值之後,此關聯依舊顯著。
  
  Gothenburg大學副教授Asa Tivesten博士表示,我們觀察到年長者之血清DHEA-S值低與後續心血管事件風險增加的關聯。這意味著DHEA-S值可提供一些有關心血管風險的資訊。一個潛在的實際意義是建立了心血管風險因素,對於DHEA-S值低的男性,應更積極評估與治療。
  
  不過,這必須有後續研究加以評估。當今,DHEA-S值並未納入心血管風險評估。
  
  Tivesten博士指出,還未確認DHEA-S之於心血管健康的機轉。對於為何DHEA-S有保護力,有一些公認的機制,例如透過抗發炎效果。
  
  不過,我們無法說DHEA-S有保護力,這篇研究並未提供有關因果之資訊,例如,我們的研究發現可能是DHEA-S有保護力的結果,也可能是DHEA-S值降低是一般健康狀況不佳的標記。
  
  Tivesten博士結論指出,需要更多研究來暸解潛在的機轉,以及評估荷爾蒙替代治療的潛在效益。
  
  資料來源: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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