1
|
Tu R, He H, Wang S, Ding J, Zeng Q, Guo L, Li Y, Xu T, Lu G. The association between healthy aging index and trajectories of disability: a population-based cohort study. Aging Clin Exp Res 2022; 34:1893-1900. [PMID: 35524107 DOI: 10.1007/s40520-022-02117-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/13/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Healthy aging index (HAI) could predict adverse health consequences including mortality and disability independent of age and comorbidity. We investigated the role of HAI on trajectories of disability throughout later life based on a nationally representative sample. METHODS We examined 1733 participants aged over 60 years from the China Health and Retirement Longitudinal Study (CHARLS) followed for 7 years/4 waves repeatedly. Systolic blood pressure [SBP], cognitive function, cystatin C, peak expiratory flow [PEF], and fasting glucose were categorized using tertile or clinical reference range, and scored as 0 (healthiest), 1 (less healthy) and 2 (least healthy) respectively to further generate HAI summary scores (range 0-10). Disability was defined as the sum of impaired activities of daily living (ADL) and instrumental activities of daily living (IADL). We used linear mixed-effects model to study the association between HAI and trajectories of disability. RESULTS A total of 10.5% of participants represented in the healthiest group and 22.5% ended up as the least healthy. After adjusting for all potential confounders, disability progression was significantly faster (β = 0.27, 95% CI 0.11-0.42) in the least healthy group when comparing with the healthiest. CONCLUSION Our findings suggest that HAI is associated with disability progression among adults aged over 60 years old. It might be beneficial for future interventions to specifically target older adults with high HAI scores as a means of reducing disability.
Collapse
|
2
|
Stevens D, Lane DA, Harrison SL, Lip GYH, Kolamunnage-Dona R. Modelling of longitudinal data to predict cardiovascular disease risk: a methodological review. BMC Med Res Methodol 2021; 21:283. [PMID: 34922465 PMCID: PMC8684210 DOI: 10.1186/s12874-021-01472-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The identification of methodology for modelling cardiovascular disease (CVD) risk using longitudinal data and risk factor trajectories. METHODS We screened MEDLINE-Ovid from inception until 3 June 2020. MeSH and text search terms covered three areas: data type, modelling type and disease area including search terms such as "longitudinal", "trajector*" and "cardiovasc*" respectively. Studies were filtered to meet the following inclusion criteria: longitudinal individual patient data in adult patients with ≥3 time-points and a CVD or mortality outcome. Studies were screened and analyzed by one author. Any queries were discussed with the other authors. Comparisons were made between the methods identified looking at assumptions, flexibility and software availability. RESULTS From the initial 2601 studies returned by the searches 80 studies were included. Four statistical approaches were identified for modelling the longitudinal data: 3 (4%) studies compared time points with simple statistical tests, 40 (50%) used single-stage approaches, such as including single time points or summary measures in survival models, 29 (36%) used two-stage approaches including an estimated longitudinal parameter in survival models, and 8 (10%) used joint models which modelled the longitudinal and survival data together. The proportion of CVD risk prediction models created using longitudinal data using two-stage and joint models increased over time. CONCLUSIONS Single stage models are still heavily utilized by many CVD risk prediction studies for modelling longitudinal data. Future studies should fully utilize available longitudinal data when analyzing CVD risk by employing two-stage and joint approaches which can often better utilize the available data.
Collapse
Affiliation(s)
- David Stevens
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK. .,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ruwanthi Kolamunnage-Dona
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
3
|
Bianchi VE, Bresciani E, Meanti R, Rizzi L, Omeljaniuk RJ, Torsello A. The role of androgens in women's health and wellbeing. Pharmacol Res 2021; 171:105758. [PMID: 34242799 DOI: 10.1016/j.phrs.2021.105758] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022]
Abstract
Androgens in women, as well as in men, are intrinsic to maintenance of (i) reproductive competency, (ii) cardiac health, (iii) appropriate bone remodeling and mass retention, (iii) muscle tone and mass, and (iv) brain function, in part, through their mitigation of neurodegenerative disease effects. In recognition of the pluripotency of endogenous androgens, exogenous androgens, and selected congeners, have been prescribed off-label for several decades to treat low libido and sexual dysfunction in menopausal women, as well as, to improve physical performance. However, long-term safety and efficacy of androgen administration has yet to be fully elucidated. Side effects often observed include (i) hirsutism, (ii) acne, (iii) deepening of the voice, and (iv) weight gain but are associated most frequently with supra-physiological doses. By contrast, short-term clinical trials suggest that the use of low-dose testosterone therapy in women appears to be effective, safe and economical. There are, however, few clinical studies, which have focused on effects of androgen therapy on pre- and post-menopausal women; moreover, androgen mechanisms of action have not yet been thoroughly explained in these subjects. This review considers clinical effects of androgens on women's health in order to prevent chronic diseases and reduce cancer risk in gynecological tissues.
Collapse
Affiliation(s)
- Vittorio E Bianchi
- Endocrinology and Metabolism, Clinical Center Stella Maris, Strada Rovereta 42, Falciano 47891, San Marino.
| | - Elena Bresciani
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy.
| | - Ramona Meanti
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy.
| | - Laura Rizzi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy.
| | - Robert J Omeljaniuk
- Department of Biology, Lakehead University, 955 Oliver Rd, Thunder Bay, Ontario P7B 5E1, Canada.
| | - Antonio Torsello
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy.
| |
Collapse
|
4
|
Relationship of dehydroepiandrosterone sulfate levels with atherosclerosis in patients with subclinical hypothyroidism. Wien Klin Wochenschr 2021; 134:45-50. [PMID: 33788012 DOI: 10.1007/s00508-021-01844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Subclinical hypothyroidism is related with increased risk of cardiovascular diseases. The decreased levels of dehydroepiandrosterone sulphate (DHEA-S) are associated with hyperlipidemia, atherosclerosis and obesity. The lower levels of DHEA‑S might be an important factor in development of atherosclerosis in subclinical hypothyroidism. METHODS A total of 126 patients (62 with subclinical hypothyroidism and 64 healthy individuals) were included in this prospectively designed study between January 2017 and December 2019. All individuals were evaluated according to DHEA‑S levels, carotid intima media thickness (CIMT) and anthropometric measurements. Blood samples were obtained from patients after 8 h fasting. The groups were statistically compared. RESULTS The mean ages of control group and patients with subclinical hypothyroidism were 36.9 ± 11.0 years and 39.6 ± 11.0 years, respectively (p = 0.165). The mean waist circumferences in controls and patients were 89 ± 10.7 cm and 91.3 ± 11.1 cm, respectively (p < 0.001). The DHEA‑S levels were 131.04 ± 96.02 µg/dl in patients, and these levels were significantly decreased in patients with subclinical hypothyroidism (p = 0.024). The levels of DHEA‑S were found to be negatively correlated with CIMT (p < 0.001, c = 0.406). CONCLUSIONS The early detection of cardiac and metabolic dysfunctions in subclinical hypothyroidism is important to avoid complications. We found a negative correlation between DHEA‑S levels and metabolic and cardiovascular risk factors in subclinical hypothyroidism. We believe that our results would attract more attention to the studies investigating relationships between DHEA‑S levels and cardiovascular complications of subclinical hypothyroidism.
Collapse
|
5
|
Jia X, Sun C, Tang O, Gorlov I, Nambi V, Virani SS, Villareal DT, Taffet GE, Yu B, Bressler J, Boerwinkle E, Windham BG, de Lemos JA, Matsushita K, Selvin E, Michos ED, Hoogeveen RC, Ballantyne CM. Plasma Dehydroepiandrosterone Sulfate and Cardiovascular Disease Risk in Older Men and Women. J Clin Endocrinol Metab 2020; 105:dgaa518. [PMID: 32785663 PMCID: PMC7526732 DOI: 10.1210/clinem/dgaa518] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
CONTEXT Lower dehydroepiandrosterone-sulfate (DHEA-S) levels have been inconsistently associated with coronary heart disease (CHD) and mortality. Data are limited for heart failure (HF) and association between DHEA-S change and events. OBJECTIVE Assess associations between low DHEA-S/DHEA-S change and incident HF hospitalization, CHD, and mortality in older adults. DESIGN DHEA-S was measured in stored plasma from visits 4 (1996-1998) and 5 (2011-2013) of the Atherosclerosis Risk in Communities study. Follow-up for incident events: 18 years for DHEA-S level; 5.5 years for DHEA-S change. SETTING General community. PARTICIPANTS Individuals without prevalent cardiovascular disease (n = 8143, mean age 63 years). MAIN OUTCOME MEASURE Associations between DHEA-S and incident HF hospitalization, CHD, or mortality; associations between 15-year change in DHEA-S (n = 3706) and cardiovascular events. RESULTS DHEA-S below the 15th sex-specific percentile of the study population (men: 55.4 µg/dL; women: 27.4 µg/dL) was associated with increased HF hospitalization (men: hazard ratio [HR] 1.30, 95% confidence interval [CI], 1.07-1.58; women: HR 1.42, 95% CI, 1.13-1.79); DHEA-S below the 25th sex-specific percentile (men: 70.0 µg/dL; women: 37.1 µg/dL) was associated with increased death (men: HR 1.12, 95% CI, 1.01-1.25; women: HR 1.19, 95% CI, 1.03-1.37). In men, but not women, greater percentage decrease in DHEA-S was associated with increased HF hospitalization (HR 1.94, 95% CI, 1.11-3.39). Low DHEA-S and change in DHEA-S were not associated with incident CHD. CONCLUSIONS Low DHEA-S is associated with increased risk for HF and mortality but not CHD. Further investigation is warranted to evaluate mechanisms underlying these associations.
Collapse
Affiliation(s)
| | | | - Olive Tang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Vijay Nambi
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Salim S Virani
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | | | | | - Bing Yu
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Jan Bressler
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Eric Boerwinkle
- University of Texas Health Science Center at Houston, Houston, Texas
| | - B Gwen Windham
- University of Mississippi School of Medicine, Jackson, Mississippi
| | | | | | - Elizabeth Selvin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Erin D Michos
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | |
Collapse
|
6
|
Fahy GM, Brooke RT, Watson JP, Good Z, Vasanawala SS, Maecker H, Leipold MD, Lin DTS, Kobor MS, Horvath S. Reversal of epigenetic aging and immunosenescent trends in humans. Aging Cell 2019; 18:e13028. [PMID: 31496122 PMCID: PMC6826138 DOI: 10.1111/acel.13028] [Citation(s) in RCA: 262] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/16/2019] [Accepted: 08/04/2019] [Indexed: 12/15/2022] Open
Abstract
Epigenetic “clocks” can now surpass chronological age in accuracy for estimating biological age. Here, we use four such age estimators to show that epigenetic aging can be reversed in humans. Using a protocol intended to regenerate the thymus, we observed protective immunological changes, improved risk indices for many age‐related diseases, and a mean epigenetic age approximately 1.5 years less than baseline after 1 year of treatment (−2.5‐year change compared to no treatment at the end of the study). The rate of epigenetic aging reversal relative to chronological age accelerated from −1.6 year/year from 0–9 month to −6.5 year/year from 9–12 month. The GrimAge predictor of human morbidity and mortality showed a 2‐year decrease in epigenetic vs. chronological age that persisted six months after discontinuing treatment. This is to our knowledge the first report of an increase, based on an epigenetic age estimator, in predicted human lifespan by means of a currently accessible aging intervention.
Collapse
Affiliation(s)
| | | | - James P. Watson
- UCLA Division of Plastic and Reconstructive Surgery David Geffen School of Medicine Los Angeles CA USA
| | - Zinaida Good
- Departments of Microbiology and Immunology Stanford University Stanford CA USA
| | | | - Holden Maecker
- Institute for Immunity, Transplantation and Infection, Stanford School of Medicine Human Immune Monitoring Center Stanford CA USA
| | - Michael D. Leipold
- Institute for Immunity, Transplantation and Infection, Stanford School of Medicine Human Immune Monitoring Center Stanford CA USA
| | - David T. S. Lin
- Department of Medical Genetics, BC Children's Hospital Research Institute Centre for Molecular Medicine and Therapeutics, University of British Columbia Vancouver BC Canada
| | - Michael S. Kobor
- Department of Medical Genetics, BC Children's Hospital Research Institute Centre for Molecular Medicine and Therapeutics, University of British Columbia Vancouver BC Canada
| | - Steve Horvath
- Human Genetics, David Geffen School of Medicine University of California Los Angeles CA USA
| |
Collapse
|
7
|
Sanders JL, Arnold AM, Boudreau RM, Hirsch CH, Kizer JR, Kaplan RC, Cappola AR, Cushman M, Jacob ME, Kritchevsky SB, Newman AB. Association of Biomarker and Physiologic Indices With Mortality in Older Adults: Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2019; 74:114-120. [PMID: 29659743 DOI: 10.1093/gerona/gly075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/09/2018] [Indexed: 12/11/2022] Open
Abstract
Background A goal of gerontology is discovering aging phenotypes that reflect biological aging distinct from disease pathogenesis. Biomarkers that strongly and independently associated with mortality and that statistically attenuated chronologic age could be used to define such a phenotype. We determined the association of a Biomarker Index (BI) with mortality and compared it with a validated Physiologic Index (PI) in older adults. Methods The indices were constructed in the Cardiovascular Health Study, mean (SD) age 74.5 (5.1) years. The BI incorporated circulating levels of new biomarkers, including insulin-like growth factor-1, insulin-like growth factor-binding protein 3, amino-terminal pro-B-type natriuretic peptide, dehydroepiandrosterone sulfate, and interleukin-6, and was built in test (N = 2,197) and validation (N = 1,124) samples. The PI included carotid intima-media thickness, pulmonary capacity, brain white matter grade, cystatin-C, and fasting glucose. Multivariable Cox proportional hazards models predicting death were calculated with 10 years of follow-up. Results In separate age-adjusted models, the hazard ratio for mortality per point of the BI was 1.30 (95% confidence interval 1.25, 1.34) and the BI attenuated age by 25%. The hazard ratio for the PI was 1.28 (1.24, 1.33; 29% age attenuation). In the same model, the hazard ratio for the BI was 1.23 (1.18, 1.28) and for the PI was 1.22 (1.17, 1.26), and age was attenuated 42.5%. Associations persisted after further adjustment. Conclusions The BI and PI were significantly and independently associated with mortality. Both attenuated the age effect on mortality substantially. The indices may be feasible phenotypes for developing interventions hoping to alter the trajectory of aging.
Collapse
Affiliation(s)
- Jason L Sanders
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle
| | | | - Calvin H Hirsch
- Department of Medicine, University of California-Davis, Sacramento
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Anne R Cappola
- Department of Medicine, University of Pennsylvania, Philadelphia
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Burlington
| | - Mini E Jacob
- New England GRECC, VA Boston Healthcare System, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Stephen B Kritchevsky
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| |
Collapse
|
8
|
Changes in androstenedione, dehydroepiandrosterone, testosterone, estradiol, and estrone over the menopausal transition. Womens Midlife Health 2017; 3. [PMID: 29333273 PMCID: PMC5761074 DOI: 10.1186/s40695-017-0028-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Previous reports have noted that dehydroepiandrosterone-sulfate (DHEAS) increases prior to the final menstrual period (FMP) and remains stable beyond the FMP. How DHEAS concentrations correspond with other sex hormones across the menopausal transition (MT) including androstenedione (A4), testosterone (T), estrone (E1), and estradiol (E2) is not known. Our objective was to examine how DHEAS, A4, T, E1, and E2 changed across the MT by White vs. African-American (AA) race/ethnicity. Methods We conducted a longitudinal observational analysis of a subgroup of women from the Study of Women’s Health Across the Nation observed over 4 visits prior to and 4 visits after the FMP (n = 110 women over 9 years for 990 observations). The main outcome measures were DHEAS, A4, T, E1, and E2. Results Compared to the decline in E2 concentrations, androgen concentrations declined minimally over the MT. T (β 9.180, p < 0.0001) and E1 (β 11.365, p < 0.0001) were higher in Whites than in AAs, while elevations in DHEAS (β 28.80, p = 0.061) and A4 (β 0.2556, p = 0.052) were borderline. Log-transformed E2 was similar between Whites and AAs (β 0.0764, p = 0.272). Body mass index (BMI) was not significantly associated with concentrations of androgens or E1 over time. Conclusion This report suggests that the declines in E2 during the 4 years before and after the FMP are accompanied by minimal changes in DHEAS, A4, T, and E1. There are modest differences between Whites and AAs and minimal differences by BMI.
Collapse
|
9
|
Wu TT, Chen Y, Zhou Y, Adi D, Zheng YY, Liu F, Ma YT, Xie X. Prognostic Value of Dehydroepiandrosterone Sulfate for Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.116.004896. [PMID: 28476876 PMCID: PMC5524067 DOI: 10.1161/jaha.116.004896] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of the present study was to estimate the impact of dehydroepiandrosterone sulfate (DHEAS) on the prognosis of patients with cardiovascular disease by performing a systematic review and meta-analysis. METHODS AND RESULTS The Embase, PubMed, Web of Science, CNKI, and WanFang databases were searched up to September 5, 2016, to identify eligible studies. The quality of each study was assessed using the Newcastle-Ottawa Scale. The association between DHEAS, either on admission or at discharge, and cardiovascular disease outcomes were reviewed. The overall risk ratio for the effect of DHEAS on all-cause mortality and fatal and nonfatal cardiovascular events was pooled using a fixed-effects or a random-effects model. The publication bias was evaluated using funnel plots. Twenty-five studies were included for systematic review. The follow-up duration ranged from 1 to 19 years. Eighteen studies were included in the meta-analysis. We found that lower DHEAS levels indicated a significant increased risk for all-cause mortality (risk ratio, 1.47; 95% CI, 1.38-1.56 [P<0.00001]), fatal cardiovascular event (risk ratio, 1.58; 95% CI, 1.30-1.91 [P<0.00001]), and nonfatal cardiovascular event (risk ratio, 1.42; 95% CI, 1.24-1.62 [P<0.0001]) in patients with cardiovascular disease. CONCLUSIONS Patients with cardiovascular disease who have lower DHEAS levels may have poorer prognosis than those with higher DHEAS levels.
Collapse
Affiliation(s)
- Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yuan Chen
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yun Zhou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dilare Adi
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| |
Collapse
|
10
|
Newman AB, Sanders JL, Kizer JR, Boudreau RM, Odden MC, Zeki Al Hazzouri A, Arnold AM. Trajectories of function and biomarkers with age: the CHS All Stars Study. Int J Epidemiol 2016; 45:1135-1145. [PMID: 27272182 PMCID: PMC5841627 DOI: 10.1093/ije/dyw092] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Multimorbidity is a major driver of physical and cognitive impairment, but rates of decline are also related to ageing. We sought to determine trajectories of decline in a large cohort by disease status, and examined their correspondence with biomarkers of ageing processes including growth hormone, sex steroid, inflammation, visceral adiposity and kidney function pathways. METHODS We have followed the 5888 participants in the Cardiovascular Health Study (CHS) for healthy ageing and longevity since 1989-90. Gait speed, grip strength, modified mini-mental status examination (3MSE) and the digit symbol substitution test (DSST) were assessed annually to 1998-99 and again in 2005-06. Insulin-like growth hormone (IGF-1), dehydroepiandrosterone sulphate (DHEAS), interleukin-6 (IL-6), adiponectin and cystatin-C were assessed 3-5 times from stored samples. Health status was updated annually and dichotomized as healthy vs not healthy. Trajectories for each function measure and biomarker were estimated using generalized estimating equations as a function of age and health status using standardized values. RESULTS Trajectories of functional decline showed strong age acceleration late in life in healthy older men and women as well as in chronically ill older adults. Adiponectin, IL-6 and cystatin-C tracked with functional decline in all domains; cystatin-C was consistently associated with functional declines independent of other biomarkers. DHEAS was independently associated with grip strength and IL-6 with grip strength and gait speed trajectories. CONCLUSIONS Functional decline in late life appears to mark a fundamental ageing process in that it occurred and was accelerated in late life regardless of health status. Cystatin C was most consistently associated with these functional declines.
Collapse
Affiliation(s)
- Anne B Newman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason L Sanders
- Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital, and Brigham and Women's Hospital Department of Emergency Medicine, Boston, MA, USA
| | - Jorge R Kizer
- Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, Bronx, NY, USA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle C Odden
- Department of Epidemiology, Oregon State University, Corvallis, OR, USA
| | | | - Alice M Arnold
- Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA, USA
| |
Collapse
|
11
|
Serum dehydroepiandrosterone sulfate and incident depression in the elderly: the Pro.V.A. study. Am J Geriatr Psychiatry 2015; 23:863-71. [PMID: 25537161 DOI: 10.1016/j.jagp.2014.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/14/2014] [Accepted: 10/30/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Dehydroepiandrosterone sulfate (DHEAS) appears to have a protective effect against depression, but contrasting findings are available. Therefore, we investigated whether high serum DHEAS levels were associated with any protective effect on incident depression and incident severe depression in a representative group of elderly men and women. METHODS In a population-based cohort longitudinal study in the general community, 789 older participants without depression and cognitive impairment at the baseline were included, among 3,099 screened subjects. Serum DHEAS levels were determined based on blood samples; incident depression and severe depression were diagnosed by means of the Geriatric Depression Scale (GDS) and confirmed by geriatricians skilled in psychogeriatric medicine. RESULTS No baseline differences were found in GDS across age- and gender-specific tertiles of serum DHEAS. Over 4.4 years of follow-up, 137 new cases of depression were recorded. Of them, 35 among men and 64 in women were cases of incident severe depression. Cox's regression analysis, adjusted for potential confounders, revealed that higher DHEAS levels were associated with reduced risk of incident depression irrespective of gender (HR: 0.30; 95% CI: 0.09-0.96; Wald χ(2) = 4.09; df = 1; p = 0.04; women: HR: 0.31; 95% CI: 0.14-0.69; Wald χ(2) = 8.37; df = 1; p = 0.004) and of severe incident depression only in men (HR: 0.25; 95% CI: 0.06-0.99; Wald χ(2) = 4.05; df = 1; p = 0.04). CONCLUSION Higher serum DHEAS levels were found to be significantly protective for the onset of depression irrespective of gender, whereas only in men was this association found also for incident severe depression.
Collapse
|
12
|
Metti AL, Aizenstein H, Yaffe K, Boudreau RM, Newman A, Launer L, Gianaros PJ, Lopez OL, Saxton J, Ives DG, Kritchevsky S, Vallejo AN, Rosano C. Trajectories of peripheral interleukin-6, structure of the hippocampus, and cognitive impairment over 14 years in older adults. Neurobiol Aging 2015; 36:3038-3044. [PMID: 26279115 DOI: 10.1016/j.neurobiolaging.2015.07.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 01/21/2023]
Abstract
We aimed to investigate if trajectory components (baseline level, slope, and variability) of peripheral interleukin-6 (IL-6) over time were related to cognitive impairment and smaller hippocampal volume and if hippocampal volume explained the associations between IL-6 and cognitive impairment. Multivariable regression models were used to test the association between IL-6 trajectory components with change in neuroimaging measures of the hippocampus and with cognitive impairment among 135 older adults (70-79 years at baseline) from the Healthy Brain Project over 14 years. IL-6 variability was positively associated with cognitive impairment (odds ratio [OR] = 5.86, 95% confidence interval [CI]: 1.24, 27.61) and with greater decrease per year of gray matter volume of the hippocampus (β = -0.008, standard error = 0.004, p = 0.03). After adjustment for hippocampal volume, the OR of cognitive impairment decreased for each unit of IL-6 variability and CIs widened (OR = 4.36, 95% CI: 0.67, 28.29). Neither baseline levels nor slopes of IL-6 were related to cognitive impairment or hippocampal volume. We believe this has potential clinical and public health implications by suggesting adults with stable levels of peripheral IL-6 may be better targets for intervention studies for slowing or preventing cognitive decline.
Collapse
Affiliation(s)
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lenore Launer
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, MD, USA
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Judith Saxton
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diane G Ives
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen Kritchevsky
- Department of Internal Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Abbe N Vallejo
- Division of Pediatric Rheumatology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA; Department of Pediatrics and Immunology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
13
|
Ohlsson C, Vandenput L, Tivesten A. DHEA and mortality: what is the nature of the association? J Steroid Biochem Mol Biol 2015; 145:248-53. [PMID: 24704256 DOI: 10.1016/j.jsbmb.2014.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 03/04/2014] [Accepted: 03/16/2014] [Indexed: 12/19/2022]
Abstract
Although very little is known about the importance of dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEA-S) in human physiology and pathophysiology, emerging observations imply pivotal roles of DHEA/-S. One such observation is the association between serum DHEA/-S levels and mortality risk. In this review, we focus on the literature addressing DHEA/-S and mortality with the aim to describe and discuss patterns and potential underlying mechanisms. Although the literature reports somewhat inconsistent results, we conclude that several larger population-based studies support an association between low DHEA/-S and risk of death, at least in elderly men. In women, the association may not be present; alternatively, there may be a U-shaped association. In men, most available evidence suggests an association with cardiovascular (CV) mortality rather than cancer mortality. Further, there are biologically plausible mechanisms for an effect of DHEA/-S on the development of CV disease. On the other hand, there is also strong evidence supporting that any disease may lower DHEA/-S. Thus, the cause-effect relation of this association is less clear. Future studies may employ a mendelian randomization approach using genetic determinants of DHEA-S levels as predictors of clinical outcomes, to delineate the true nature of the association between DHEA/-S and mortality.
Collapse
Affiliation(s)
- Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Liesbeth Vandenput
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Asa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Bruna Stråket 16, S-413 45 Gothenburg, Sweden.
| |
Collapse
|
14
|
Varadhan R, Xue QL, Bandeen-Roche K. Semicompeting risks in aging research: methods, issues and needs. LIFETIME DATA ANALYSIS 2014; 20:538-62. [PMID: 24729136 PMCID: PMC4430119 DOI: 10.1007/s10985-014-9295-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 03/21/2014] [Indexed: 05/04/2023]
Abstract
A semicompeting risks problem involves two-types of events: a nonterminal and a terminal event (death). Typically, the nonterminal event is the focus of the study, but the terminal event can preclude the occurrence of the nonterminal event. Semicompeting risks are ubiquitous in studies of aging. Examples of semicompeting risk dyads include: dementia and death, frailty syndrome and death, disability and death, and nursing home placement and death. Semicompeting risk models can be divided into two broad classes: models based only on observables quantities (class [Formula: see text]) and those based on potential (latent) failure times (class [Formula: see text]). The classical illness-death model belongs to class [Formula: see text]. This model is a special case of the multistate models, which has been an active area of methodology development. During the past decade and a half, there has also been a flurry of methodological activity on semicompeting risks based on latent failure times ([Formula: see text] models). These advances notwithstanding, the semicompeting risks methodology has not penetrated biomedical research, in general, and gerontological research, in particular. Some possible reasons for this lack of uptake are: the methods are relatively new and sophisticated, conceptual problems associated with potential failure time models are difficult to overcome, paucity of expository articles aimed at educating practitioners, and non-availability of readily usable software. The main goals of this review article are: (i) to describe the major types of semicompeting risks problems arising in aging research, (ii) to provide a brief survey of the semicompeting risks methods, (iii) to suggest appropriate methods for addressing the problems in aging research, (iv) to highlight areas where more work is needed, and (v) to suggest ways to facilitate the uptake of the semicompeting risks methodology by the broader biomedical research community.
Collapse
Affiliation(s)
- Ravi Varadhan
- Division of Geriatric Medicine and Gerontology, The Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA,
| | | | | |
Collapse
|
15
|
Fabbri E, An Y, Zoli M, Simonsick EM, Guralnik JM, Bandinelli S, Boyd CM, Ferrucci L. Aging and the burden of multimorbidity: associations with inflammatory and anabolic hormonal biomarkers. J Gerontol A Biol Sci Med Sci 2014; 70:63-70. [PMID: 25104822 DOI: 10.1093/gerona/glu127] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multimorbidity increases with aging, but risk factors beyond age are unknown. OBJECTIVE To investigate the association of inflammatory and anabolic hormonal biomarkers with presence and prospective development of multimorbidity. METHODS Nine-year longitudinal study of 1018 participants aged 60 years or older (InCHIANTI Study). Multimorbidity was evaluated at baseline and follow-up visits as number of diagnosed diseases from a predefined list of 15 candidate chronic conditions, defined according to standard clinical criteria. Linear mixed models were used to test cross-sectional and longitudinal associations between candidate biomarkers and multimorbidity. RESULTS At baseline, multimorbidity was significantly higher in older participants (p < .001) and higher IL-6, IL-1ra, TNF-α receptor II (TNFAR2), and lower dehydroepiandrosterone sulfate were associated with higher number of diseases, independent of age, sex, body mass index, and education. The rate of longitudinal increase in number of chronic diseases was significantly steeper in participants who were older at baseline (p < .001). In addition, higher baseline IL-6 and steeper increase of IL-6 levels were significantly and independently associated with a steeper increase in multimorbidity over time (p < .001 and p = .003, respectively). Sensitivity analyses, performed using 15 different models obtained by removing each of 15 conditions included in the original list of candidate diseases, confirmed that results were not driven by any specific condition. CONCLUSIONS Accumulation of chronic diseases accelerates at older ages and in persons with higher baseline levels and steeper increase over time of IL-6. High IL-6 and increase in IL-6 may serve as early warning sign to better target interventions aimed at reducing the burden of multimorbidity.
Collapse
Affiliation(s)
- Elisa Fabbri
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland. Department of Medical and Surgical Sciences, University of Bologna, Italy.
| | - Yang An
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, Division of Gerontology, University of Maryland School of Medicine, Baltimore
| | | | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| |
Collapse
|
16
|
Metti AL, Yaffe K, Boudreau RM, Simonsick EM, Carnahan RM, Satterfield S, Harris TB, Ayonayon HN, Rosano C, Cauley JA. Trajectories of inflammatory markers and cognitive decline over 10 years. Neurobiol Aging 2014; 35:2785-2790. [PMID: 24997674 DOI: 10.1016/j.neurobiolaging.2014.05.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/22/2014] [Accepted: 05/31/2014] [Indexed: 10/25/2022]
Abstract
We aimed to examine trajectories of inflammatory markers and cognitive decline over 10 years. Cox proportional hazards models were used to examine the association between interleukin-6 and C-reactive protein (CRP) trajectory components (slope, variability, and baseline level) and cognitive decline among 1323 adults, aged 70-79 years in the Health, Aging, and Body Composition Study. We tested for interactions by sex and apolipoprotein E (APOE) genotype. In models adjusted for multiple covariates and comorbidities, extreme CRP variability was significantly associated with cognitive decline (hazard ratio [HR] 1.6, 95% confidence interval [CI]: 1.1-2.3). This association was modified by sex and APOE e4 (p < 0.001 for both), such that the association remained among women (HR = 1.8; 95% CI: 1.1, 3.0) and among those with no APOE e4 allele (HR = 1.6; 95% CI: 1.1, 2.5). There were no significant associations between slope or baseline level of CRP and cognitive decline nor between interleukin-6 and cognitive decline. We believe CRP variability likely reflects poor control of or greater changes in vascular or metabolic disease over time, which in turn is associated with cognitive decline.
Collapse
Affiliation(s)
- Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ryan M Carnahan
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee, Memphis, TN, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | |
Collapse
|
17
|
Sanders JL, Ding V, Arnold AM, Kaplan RC, Cappola AR, Kizer JR, Boudreau RM, Cushman M, Newman AB. Do changes in circulating biomarkers track with each other and with functional changes in older adults? J Gerontol A Biol Sci Med Sci 2014; 69:174-81. [PMID: 23811185 PMCID: PMC4038245 DOI: 10.1093/gerona/glt088] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/24/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is unclear if changes in proposed circulating biomarkers of aging are strongly correlated to each other or functional change. We tested if biomarker changes track with each other and with functional measures over 9 years in older adults. METHODS Dehydroepiandrosterone sulfate (DHEAS), adiponectin, insulin-like growth factor 1 (IGF-1), IGF binding proteins 1 (IGFBP-1) and 3 (IGFBP-3), interleukin-6 (IL-6), cholesterol, and function (gait speed, grip strength, Modified Mini Mental Status Exam [3MSE] and Digit Symbol Substitution Test [DSST] scores) were measured in 1996-1997 and 2005-2006 in the Cardiovascular Health Study All Stars study (N = 901, mean [standard deviation, SD] age 85.3 [3.6] years in 2005-2006). Adjusted Pearson correlations illustrated if biomarkers tracked together. Multivariable linear regression demonstrated if biomarker changes tracked with functional changes. RESULTS Correlations among biomarker changes were mostly <0.2. In models with each biomarker entered separately, a 1-SD increase biomarker change was associated with change in function as follows: grip strength (DHEAS β = 0.61kg, p = .001; IL-6 β = -0.46kg, p = .012; cholesterol men β = 0.79kg, p = .016); gait speed (DHEAS β = 0.02 meters per second, p = .039; IL-6 β = -0.018 meters per second, p = .049); and DSST score (DHEAS women β = 1.46, p = .004; IL-6 β = -0.83, p = .027). When biomarkers were entered in the same model, significant associations remaining were as follows: grip strength (DHEAS β = 0.54kg, p = .005; IL-6 β = -0.43kg, p = .022); 3MSE score (IGF-1 β = 0.96, p = .04; IGFBP-3 β = -1.07, p = .024); and DSST score (DHEAS women β = 1.27, p = .012; IL-6 β = -0.80, p = .04). CONCLUSION Changes in biomarkers were poorly correlated, supporting a model of stochastic, independent change across systems. DHEAS and IL-6 tracked most closely with function, illustrating that changes in inflammation and sex steroids may play dominant roles in changes of these functional outcomes.
Collapse
Affiliation(s)
- Jason L Sanders
- Bellefield Professional Building 4th Floor, 130 North Bellefield Avenue, Pittsburgh, PA 15213.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Higher serum dehydroepiandrosterone sulfate levels are protectively associated with depressive symptoms in men, but not in women: a community-based cohort study of older Japanese. Am J Geriatr Psychiatry 2013; 21:1154-63. [PMID: 23567366 DOI: 10.1016/j.jagp.2013.01.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 03/12/2012] [Accepted: 06/27/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Dehydroepiandrosterone sulfate (DHEAS) appears to have a protective effect against depression, but evidence from prospective cohort studies is sparse. Therefore, we examined the association between serum DHEAS levels and depressive symptoms in older community-dwelling Japanese. DESIGN A community-based cohort study. SETTING Kurabuchi Town, Gunma Prefecture, Japan. PARTICIPANTS A total of 554 residents (248 men and 306 women) age 65 years or older without depressive symptoms at baseline. MEASUREMENTS We performed a baseline examination of the subjects between 2005 and 2006 to determine serum DHEAS levels. The subjects were categorized into three groups based on age strata- and sex-specific tertiles of DHEAS. Depressive symptoms were assessed with the Geriatric Depression Scale 15-item version (GDS-15) in face-to-face home visit interviews carried out once in 2007 and once in 2008. The association of DHEAS with depressive symptoms (GDS-15 ≥ 6) was analyzed with the use of logistic regression models. RESULTS The incidence of depressive symptoms was 12.1% in men and 19.6% in women. In men, the multiadjusted odds ratio of depressive symptoms was 0.24 (95% confidence interval: 0.06-0.94, Wald χ2 = 4.20, degrees of freedom = 1, p = 0.04) for the highest tertile compared with the lowest. The association observed for the highest versus the lowest remained significant even after adjustment for physical performance and cognitive function. In women, DHEAS was not associated with depressive symptoms. CONCLUSIONS In this study, higher serum DHEAS levels were found to be protectively and independently associated with the risk of developing depressive symptoms in men, but not in women.
Collapse
|
19
|
Haring R, Teng Z, Xanthakis V, Coviello A, Sullivan L, Bhasin S, Murabito JM, Wallaschofski H, Vasan RS. Association of sex steroids, gonadotrophins, and their trajectories with clinical cardiovascular disease and all-cause mortality in elderly men from the Framingham Heart Study. Clin Endocrinol (Oxf) 2013; 78:629-34. [PMID: 22901104 PMCID: PMC4161203 DOI: 10.1111/cen.12013] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/25/2012] [Accepted: 08/09/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Emerging data from longitudinal studies suggest that low sex steroid concentrations in men are associated with increased cardiovascular risk and mortality. The impact of longitudinal trajectory patterns from serial sex steroid and gonadotrophin measurements on the observed associations is unknown to date. METHODS We prospectively evaluated 254 elderly men (mean age, 75·5 years) of the Framingham Heart Study with up to four serial measurements of serum total testosterone (TT), dehydroepiandrosterone sulphate (DHEAS), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and total estradiol (EST); and constructed age- and multivariable-adjusted Cox proportional hazard regression models relating baseline hormone concentrations and their mean, slope and variation over time (modelled as continuous and categorized into quartiles) to the incidence of clinical cardiovascular disease (CVD) and all-cause mortality at 5- and 10-year follow-up. RESULTS We observed no association between baseline concentrations of sex steroids, gonadotrophins and their trajectories with incident clinical CVD over 5- and 10-year follow-up. Although higher baseline TT concentrations were associated with lower mortality risk at 5 years (hazard ratio per quartile increment, 0·74; 95% confidence interval, 0·56-0·98), correction for multiple statistical testing (P < 0·005) rendered this association statistically nonsignificant. Repeat analyses at the 10-year follow-up time point also demonstrated no significant association between sex steroids, gonadotrophins or their trajectories and mortality. CONCLUSION Investigating longitudinal trajectory patterns of serial sex steroid and gonadotrophin measurements, the present study found no consistent associations with incident clinical CVD and all-cause mortality risk in elderly men from the community.
Collapse
Affiliation(s)
- Robin Haring
- Preventive Medicine & Epidemiology Section, School of Medicine, Boston University, Boston, MA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Affiliation(s)
- Navneet Magon
- Department of Obstetrics and Gynecology, Air Force Hospital, Kanpur, Uttar Pradesh, India E-mail:
| | | | | |
Collapse
|
21
|
Haring R, Xanthakis V, Coviello A, Sullivan L, Bhasin S, Wallaschofski H, Murabito JM, Vasan RS. Clinical correlates of sex steroids and gonadotropins in men over the late adulthood: the Framingham Heart Study. ACTA ACUST UNITED AC 2012; 35:775-782. [PMID: 22640232 DOI: 10.1111/j.1365-2605.2012.01285.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Low serum concentrations of sex steroids and gonadotropins in men have been associated with increased cardiometabolic risk and mortality, but the clinical correlates of these hormones in men over late adulthood are less clearly understood. We analysed up to five serial measurements of total testosterone (TT), dehydroepiandrosterone sulphate (DHEAS), follicle stimulating hormone (FSH), luteinizing hormone (LH) and total estradiol (EST) in older men in the original cohort of the Framingham Heart Study to determine the short- (2-years; 1,165 person-observations in 528 individuals) and long-term (up to 10-years follow-up; 2520 person-observations in 835 individuals with mean baseline age: 71.2 years) clinical correlates of these sex steroids and gonadotropins using multilevel modelling and Generalized Estimating Equations. Age, body mass index and pre-existing type 2 diabetes were inversely related to long-term TT concentrations, whereas higher systolic blood pressure showed a positive association. Furthermore, age and pre-existing cardiovascular disease (CVD) were inversely associated and HDL cholesterol concentrations positively associated with long-term DHEAS concentrations respectively. Analyses of short-term changes revealed age was inversely related to DHEAS, but positively related to FSH and LH concentrations. Our community-based study identified modifiable correlates of decreasing TT and DHEAS concentrations in elderly men, suggesting that maintenance of a low CVD risk factor burden may mitigate the age-related decline of these hormones over the late adulthood.
Collapse
Affiliation(s)
- R Haring
- Preventive Medicine & Epidemiology Section, Boston University School of Medicine, Boston, MA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Forti P, Maltoni B, Olivelli V, Pirazzoli GL, Ravaglia G, Zoli M. Serum dehydroepiandrosterone sulfate and adverse health outcomes in older men and women. Rejuvenation Res 2012; 15:349-58. [PMID: 22524205 DOI: 10.1089/rej.2011.1248] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low serum dehydroepiandrosterone sulfate (DHEAS) is common in older persons with poor health. The geriatric syndrome of physical frailty is associated with a higher risk of developing fatal and nonfatal health outcomes. However, the association of DHEAS with frailty is uncertain. This study investigated the association of serum DHEAS with frailty and its related adverse outcomes in 416 men and 504 women aged ≥65 years from an Italian prospective population-based cohort study. At baseline, frailty status was defined according to the physical phenotype, and serum DHEAS was measured in a fasting venous blood sample. After 4 years, subjects were reassessed for incident frailty and occurrence of nonfatal frailty-related outcomes (hospital admission, nursing home placement, disability, falls, and fractures). All-cause mortality after 8 years was also recorded. Incident frailty was inversely associated with baseline log-transformed DHEAS in men (odds ratio [OR]=0.35, 95% confidence interval [CI] 0.14-0.88, p=0.026) but not in women. Independent of baseline frailty status, women in the lowest DHEAS quartile compared to the upper three quartiles had a higher risk of hospital admission (OR=0.44, 95% CI 0.21-0.91, p=0.027) and nursing home placement (OR=0.27, 95% CI 0.08-0.95, p=0.041). Baseline log-transformed serum DHEAS was also inversely associated with mortality risk, but limited to women with concurrent frailty (hazard ratio [HR]=0.27, 95% CI 0.11-0.68, p=0.005) or preexisting major diseases (HR=0.57, 95% CI 0.33-0.98, p=0.041). These findings suggest that DHEAS is associated with incident frailty in older men and with fatal and nonfatal frailty-related adverse outcomes in older women.
Collapse
Affiliation(s)
- Paola Forti
- Department of Internal Medicine, Aging, and Nephrology, University of Bologna, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
23
|
Nagaya T, Kondo Y, Okinaka T. Serum dehydroepiandrosterone-sulfate reflects age better than health status, and may increase with cigarette smoking and alcohol drinking in middle-aged men. Aging Clin Exp Res 2012; 24:134-8. [PMID: 22842832 DOI: 10.1007/bf03325159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Serum dehydroepiandrosterone- sulfate (DHEAS), the most abundant adrenal steroid hormone, may predict aging status and longevity in humans. The aims of this study are to clarify the fundamental properties of serum DHEAS as a biomarker for health in middle-aged men. METHODS We investigated correlations of serum DHEAS with age or conventional health indices (body mass index, blood pressure, and 12 serum/blood tests) and associations of serum DHEAS with lifestyle factors (smoking, drinking, exercise, sleep) in 384 healthy men aged 30-49 years, randomly selected from voluntary attendees at a checkup. RESULTS Serum DHEAS had an inverse and stronger correlation with age (Spearman's r=-0.320, p<0.001) than with any conventional health indices used here. Regardless of age and BMI adjustments, serum DHEAS had a weak correlation with serum uric acid (crude Spearman's r=0.198, p<0.001), and its correlations with other conventional health indices were weaker or non-significant. Serum DHEAS rose in parallel with increased smoking and alcohol intake (p for trend <0.001 in both), but had no significant relationships with exercise or sleep. CONCLUSIONS Serum DHEAS reflects age better than health status evaluated by conventional health indices, and may increase with cigarette smoking and alcohol drinking in middle-aged healthy men.
Collapse
Affiliation(s)
- Teruo Nagaya
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | | | | |
Collapse
|
24
|
Traish AM, Kang HP, Saad F, Guay AT. Dehydroepiandrosterone (DHEA)—A Precursor Steroid or an Active Hormone in Human Physiology (CME). J Sex Med 2011; 8:2960-82; quiz 2983. [DOI: 10.1111/j.1743-6109.2011.02523.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
25
|
Prom-Wormley EC, York TP, Jacobson KC, Eaves LJ, Mendoza SP, Hellhammer D, Maninger N, Levine S, Lupien S, Lyons MJ, Hauger R, Xian H, Franz CE, Kremen WS. Genetic and environmental effects on diurnal dehydroepiandrosterone sulfate concentrations in middle-aged men. Psychoneuroendocrinology 2011; 36:1441-52. [PMID: 21570195 PMCID: PMC3183407 DOI: 10.1016/j.psyneuen.2011.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 01/27/2011] [Accepted: 03/29/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Dehydroepiandrosterone sulfate (DHEAS) is important for its association with immune system function and health outcomes. The characterization of the genetic and environmental contributions to daily DHEAS concentrations is thus important for understanding the genetics of health and aging. METHODS Saliva was collected from 783 middle-aged men (389 complete pairs and 5 unpaired twins) as part of the Vietnam Era Twin Study of Aging. Samples were taken at multiple specified time points across two non-consecutive days in the home and one day at the study sites. A twin modeling approach was used to estimate genetic and environmental contributions for time-specific and average DHEAS concentrations. RESULTS There was a consistent diurnal pattern for DHEAS concentrations in both at-home and day-of-testing (DOT) measures, which was the highest at awakening and decreased slightly throughout the day. Heritability estimates were significant for measures at 10 am, 3 pm and bedtime for the in-home days and at 10 am and 3 pm on the DOT, ranging between 0.37 and 0.46. CONCLUSIONS The significant heritability estimates later in the day reflect time-specific genetic effects for DHEAS, compared with prior twin and family designs studies which frequently used averaged morning-only measures. Additive genetic influences on DHEAS concentrations were consistent between at-home and DOT measures.
Collapse
Affiliation(s)
| | - Timothy P. York
- Virginia Institute for Behavioral and Psychiatric Genetics, Virginia Commonwealth University
| | | | - Lindon J. Eaves
- Virginia Institute for Behavioral and Psychiatric Genetics, Virginia Commonwealth University
| | - Sally P. Mendoza
- California National Primate Research Center, University of California Davis
| | | | - Nicole Maninger
- California National Primate Research Center, University of California Davis
| | - Seymour Levine
- Department of Psychiatry, University of California Davis
| | - Sonia Lupien
- Mental Health Research Centre Fernand Seguin, Hôpital Louis-H Lafontaine, Université de Montréal, Canada
| | | | - Richard Hauger
- Department of Psychiatry, University of California San Diego,VA San Diego Healthcare System
| | - Hong Xian
- Department of Internal Medicine, Washington University
| | - Carol E. Franz
- Department of Psychiatry, University of California San Diego
| | - William S. Kremen
- Department of Psychiatry, University of California San Diego,VA San Diego Healthcare System
| |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW Levels of dehydroepiandrosterone (DHEA) are known to decline with age. In an era of increasing use of supplements to better life, the benefits of DHEA in the aging female population are controversial. The goal of this article is to critically review published studies to determine if there is a role for DHEA supplementation in postmenopausal women. RECENT FINDINGS Daily administration of oral DHEA achieves serum concentrations similar to those of women in their 20s. Several observational studies have shown that lower DHEA levels are associated with increased cardiovascular risk in women; however, interventional trials show no improvement in atherosclerosis or cardiovascular risk factors, and a lowering of HDL cholesterol levels. DHEA supplementation modestly increases bone mineral density in conjunction with adjuvant therapies and improves cognition in those with mild-to-moderate cognitive impairment, but does not affect cognition in unimpaired women. Use of intravaginal DHEA, but not oral DHEA, alleviates vaginal atrophy and improves sexual function in postmenopausal women. SUMMARY On the basis of current evidence, there is no role for oral DHEA supplementation in healthy, postmenopausal women. Where benefits have been shown, long-term studies are needed to confirm these benefits and verify the safety profile of DHEA.
Collapse
Affiliation(s)
- Rachna M Goel
- Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
| | | |
Collapse
|
27
|
Current world literature. Curr Opin Endocrinol Diabetes Obes 2011; 18:231-4. [PMID: 21844704 DOI: 10.1097/med.0b013e3283473d73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Zhai G, Teumer A, Stolk L, Perry JRB, Vandenput L, Coviello AD, Koster A, Bell JT, Bhasin S, Eriksson J, Eriksson A, Ernst F, Ferrucci L, Frayling TM, Glass D, Grundberg E, Haring R, Hedman ÅK, Hofman A, Kiel DP, Kroemer HK, Liu Y, Lunetta KL, Maggio M, Lorentzon M, Mangino M, Melzer D, Miljkovic I, Nica A, Penninx BWJH, Vasan RS, Rivadeneira F, Small KS, Soranzo N, Uitterlinden AG, Völzke H, Wilson SG, Xi L, Zhuang WV, Harris TB, Murabito JM, Ohlsson C, Murray A, de Jong FH, Spector TD, Wallaschofski H. Eight common genetic variants associated with serum DHEAS levels suggest a key role in ageing mechanisms. PLoS Genet 2011; 7:e1002025. [PMID: 21533175 PMCID: PMC3077384 DOI: 10.1371/journal.pgen.1002025] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 01/27/2011] [Indexed: 01/12/2023] Open
Abstract
Dehydroepiandrosterone sulphate (DHEAS) is the most abundant circulating steroid secreted by adrenal glands--yet its function is unknown. Its serum concentration declines significantly with increasing age, which has led to speculation that a relative DHEAS deficiency may contribute to the development of common age-related diseases or diminished longevity. We conducted a meta-analysis of genome-wide association data with 14,846 individuals and identified eight independent common SNPs associated with serum DHEAS concentrations. Genes at or near the identified loci include ZKSCAN5 (rs11761528; p = 3.15 × 10(-36)), SULT2A1 (rs2637125; p = 2.61 × 10(-19)), ARPC1A (rs740160; p = 1.56 × 10(-16)), TRIM4 (rs17277546; p = 4.50 × 10(-11)), BMF (rs7181230; p = 5.44 × 10(-11)), HHEX (rs2497306; p = 4.64 × 10(-9)), BCL2L11 (rs6738028; p = 1.72 × 10(-8)), and CYP2C9 (rs2185570; p = 2.29 × 10(-8)). These genes are associated with type 2 diabetes, lymphoma, actin filament assembly, drug and xenobiotic metabolism, and zinc finger proteins. Several SNPs were associated with changes in gene expression levels, and the related genes are connected to biological pathways linking DHEAS with ageing. This study provides much needed insight into the function of DHEAS.
Collapse
Affiliation(s)
- Guangju Zhai
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Alexander Teumer
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Lisette Stolk
- Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
- Netherlands Consortium of Healthy Ageing, Rotterdam, The Netherlands
| | - John R. B. Perry
- Genetics of Complex Traits, Peninsula Medical School, University of Exeter, Exeter, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Liesbeth Vandenput
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrea D. Coviello
- Sections of General Internal Medicine, Preventive Medicine, Cardiology and Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Annemarie Koster
- Laboratory for Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland, United States of America
| | - Jordana T. Bell
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Shalender Bhasin
- Section of Endocrinology, Diabetes, and Nutrition, Claude D. Pepper Older Americans Independence Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Joel Eriksson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Eriksson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Florian Ernst
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Luigi Ferrucci
- Clinical Research Branch, National Institute on Aging, Baltimore, Maryland, United States of America
| | - Timothy M. Frayling
- Genetics of Complex Traits, Peninsula Medical School, University of Exeter, Exeter, United Kingdom
| | - Daniel Glass
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Elin Grundberg
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Wellcome Trust Sanger Institute, Hixton, United Kingdom
| | - Robin Haring
- Institute for Clinical Chemistry and Laboratory Medicine, University of Greifswald, Greifswald, Germany
| | - Åsa K. Hedman
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Albert Hofman
- Netherlands Consortium of Healthy Ageing, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Douglas P. Kiel
- Hebrew Senior Life Institute for Aging Research and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Heyo K. Kroemer
- Center of Pharmacology and Experimental Therapeutics, Department of Pharmacology, University of Greifswald, Greifswald, Germany
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States of America
| | - Kathryn L. Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Marcello Maggio
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy
| | - Mattias Lorentzon
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - David Melzer
- Genetics of Complex Traits, Peninsula Medical School, University of Exeter, Exeter, United Kingdom
| | - Iva Miljkovic
- Department of Epidemiology, University of Pittsburgh, Pittsburg, Pennsylvania, United States of America
| | | | - Alexandra Nica
- Wellcome Trust Sanger Institute, Hixton, United Kingdom
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | | | - Ramachandran S. Vasan
- Sections of General Internal Medicine, Preventive Medicine, Cardiology and Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, United States of America
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
- Netherlands Consortium of Healthy Ageing, Rotterdam, The Netherlands
| | - Kerrin S. Small
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Wellcome Trust Sanger Institute, Hixton, United Kingdom
| | - Nicole Soranzo
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Wellcome Trust Sanger Institute, Hixton, United Kingdom
| | - André G. Uitterlinden
- Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
- Netherlands Consortium of Healthy Ageing, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Scott G. Wilson
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, Australia
| | - Li Xi
- Molecular Medicine – Computational Biology, Pfizer Worldwide R&D, Groton, Connecticut, United States of America
| | - Wei Vivian Zhuang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Tamara B. Harris
- Laboratory for Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland, United States of America
| | - Joanne M. Murabito
- Sections of General Internal Medicine, Preventive Medicine, Cardiology and Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, United States of America
| | - Claes Ohlsson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Murray
- Genetics of Complex Traits, Peninsula Medical School, University of Exeter, Exeter, United Kingdom
| | - Frank H. de Jong
- Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Henri Wallaschofski
- Institute for Clinical Chemistry and Laboratory Medicine, University of Greifswald, Greifswald, Germany
| |
Collapse
|
29
|
Ventetuolo CE, Ouyang P, Bluemke DA, Tandri H, Barr RG, Bagiella E, Cappola AR, Bristow MR, Johnson C, Kronmal RA, Kizer JR, Lima JAC, Kawut SM. Sex hormones are associated with right ventricular structure and function: The MESA-right ventricle study. Am J Respir Crit Care Med 2011; 183:659-67. [PMID: 20889903 PMCID: PMC3081282 DOI: 10.1164/rccm.201007-1027oc] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 09/30/2010] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sex hormones have effects on the left ventricle, but hormonal influences on the right ventricle (RV) are unknown. OBJECTIVES We hypothesized that sex hormones would be associated with RV morphology in a large cohort free of cardiovascular disease. METHODS Sex hormones were measured by immunoassay and RV ejection fraction (RVEF), stroke volume (RVSV), mass, end-diastolic volume, and end-systolic volume (RVESV) were measured by cardiac magnetic resonance imaging in 1,957 men and 1,738 postmenopausal women. The relationship between each hormone and RV parameter was assessed by multivariate linear regression. MEASUREMENTS AND MAIN RESULTS Higher estradiol levels were associated with higher RVEF (β per 1 ln[nmol/L], 0.88; 95% confidence interval [CI], 0.32 to 1.43; P = 0.002) and lower RVESV (β per 1 ln[nmol/L], -0.87; 95% CI, -1.67 to -0.08; P = 0.03) in women using hormone therapy. In men, higher bioavailable testosterone levels were associated with higher RVSV (β per 1 ln[nmol/L], 1.97; 95% CI, 0.20 to 3.73; P = 0.03) and greater RV mass and volumes (P ≤ 0.01). Higher dehydroepiandrosterone levels were associated with higher RVSV (β per 1 ln[nmol/L], 1.37; 95% CI, 0.15 to 2.59; P = 0.03) and greater RV mass (β per 1 ln[nmol/L], 0.25; 95% CI, 0.00 to 0.49; P = 0.05) and volumes (P ≤ 0.001) in women. CONCLUSIONS Higher estradiol levels were associated with better RV systolic function in women using hormone therapy. Higher levels of androgens were associated with greater RV mass and volumes in both sexes.
Collapse
Affiliation(s)
- Corey E. Ventetuolo
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Pamela Ouyang
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - David A. Bluemke
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Harikrishna Tandri
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Emilia Bagiella
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Anne R. Cappola
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Michael R. Bristow
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Craig Johnson
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Richard A. Kronmal
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Jorge R. Kizer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Joao A. C. Lima
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Steven M. Kawut
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| |
Collapse
|
30
|
Fukai S, Akishita M, Yamada S, Ogawa S, Yamaguchi K, Kozaki K, Toba K, Ouchi Y. Plasma sex hormone levels and mortality in disabled older men and women. Geriatr Gerontol Int 2010; 11:196-203. [DOI: 10.1111/j.1447-0594.2010.00670.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Shufelt C, Bretsky P, Almeida CM, Johnson BD, Shaw LJ, Azziz R, Braunstein GD, Pepine CJ, Bittner V, Vido DA, Stanczyk FZ, Bairey Merz CN. DHEA-S levels and cardiovascular disease mortality in postmenopausal women: results from the National Institutes of Health--National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE). J Clin Endocrinol Metab 2010; 95:4985-92. [PMID: 20739385 PMCID: PMC2968728 DOI: 10.1210/jc.2010-0143] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 07/26/2010] [Indexed: 11/19/2022]
Abstract
CONTEXT Dehydroepiandrosterone sulfate (DHEA-S), a major circulating sex steroid prohormone, declines with age. Low levels have been associated with increased cardiovascular disease (CVD) risk and all-cause mortality, although these results have not been consistently replicated, particularly in women. OBJECTIVE Our objective was to examine the association of circulating DHEA-S levels, CVD, and mortality risk among postmenopausal women with suspected myocardial ischemia. DESIGN In the Women's Ischemia Syndrome Evaluation, 270 postmenopausal women underwent coronary angiography and blood hormone levels for suspected ischemia and were followed annually. The primary outcome of interest was CVD mortality; secondary analyses included all-cause mortality and nonfatal CVD events (myocardial infarction, stroke, and congestive heart failure) and angiographic obstructive coronary artery disease (CAD). RESULTS Women in the lowest DHEA-S tertile had higher CVD mortality (17% 6-yr mortality rate vs. 8%; log-rank P = 0.011), and all-cause mortality (21 vs. 10%; P = 0.011) compared with women with higher DHEA-S levels. The increased CVD mortality risk [hazard ratio (HR) = 2.55; 95% confidence interval (CI) = 1.19-5.45] remained unchanged after adjustment for multiple CVD risk factors (HR = 2.43; 95% CI = 1.06-5.56) but became nonsignificant when further adjusting for the presence or severity of angiographic obstructive CAD (HR = 1.99; 95% CI = 0.87-4.59). Results were similar for all-cause mortality. Lower DHEA-S levels were only marginally but not independently associated with obstructive CAD. CONCLUSIONS Among postmenopausal women with coronary risk factors undergoing coronary angiography for suspected myocardial ischemia, lower DHEA-S levels were linked with higher CVD mortality and all-cause mortality. Our study provides valuable feasibility data useful for future investigations and possible mechanistic pathways.
Collapse
Affiliation(s)
- Chrisandra Shufelt
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Sanders JL, Cappola AR, Arnold AM, Boudreau RM, Chaves PH, Robbins J, Cushman M, Newman AB. Concurrent change in dehydroepiandrosterone sulfate and functional performance in the oldest old: results from the Cardiovascular Health Study All Stars study. J Gerontol A Biol Sci Med Sci 2010; 65:976-81. [PMID: 20466773 DOI: 10.1093/gerona/glq072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The correlation between dehydroepiandrosterone sulfate (DHEAS) decline and age led to the hypothesis that DHEAS might be a marker of primary aging, though conflicting data from observational studies of mortality do not support this. We evaluated concurrent DHEAS and functional decline in a very old cohort to test if DHEAS change tracks with functional change during aging. METHODS DHEAS and functional performance (gait speed, grip strength, Modified Mini-Mental State Examination [3MSE] score, and digit symbol substitution test [DSST] score) were measured in 1996-1997 and 2005-2006 in 989 participants in the Cardiovascular Health Study All Stars study (mean age 85.2 years in 2005-2006, 63.5% women and 16.5% African American). We used multivariable linear regression to test the association of DHEAS decline with functional decline. RESULTS After adjustment, each standard deviation decrease in DHEAS was associated with greater declines in gait speed (0.12 m/s, p = .01), grip strength (0.09 kg, p = .03), 3MSE score (0.13 points, p < .001), and DSST score (0.14 points, p = .001) in women only. Additional adjustment for baseline DHEAS attenuated the association with grip strength but did not alter other estimates appreciably, and baseline DHEAS was unassociated with functional decline. CONCLUSIONS In this cohort of very old individuals, DHEAS decline tracked with declines in gait speed, 3MSE score, and DSST score, but not grip strength, in women independent of baseline DHEAS level. DHEAS decline might be a marker for age-associated performance decline, but its relevance is specific to women.
Collapse
Affiliation(s)
- J L Sanders
- Medical Scientist Training Program, School of Medicine, University of Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Sanders JL, Boudreau RM, Cappola AR, Arnold AM, Robbins J, Cushman M, Newman AB. Cardiovascular disease is associated with greater incident dehydroepiandrosterone sulfate decline in the oldest old: the cardiovascular health study all stars study. J Am Geriatr Soc 2010; 58:421-6. [PMID: 20163485 DOI: 10.1111/j.1532-5415.2010.02724.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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 Cardiovascular Health Study All Stars study participants assessed in 2005/06 (N=989, mean age 85.2, 63.5% women, 16.5% African American). MEASUREMENTS Health characteristics were assessed in 2005/06 according to DHEAS level, mean DHEAS and DHEAS change across age categories were tested, and linear and logistic regression was used to identify factors present in 1996/97 associated with continuous and categorical DHEAS change. RESULTS Mean +/- standard deviation DHEAS was 0.555 +/- 0.414 microg/mL in 1996/97 and 0.482 +/- 0.449 microg/mL in 2005/06 for women and 0.845 +/- 0.520 microg/mL in 1996/97 and 0.658 +/- 0.516 microg/mL in 2005/06 for men. In 2005/06, 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 microg/mL) than in women (-0.078 microg/mL) (P<.001). Each 1-year increase in age attenuated the effect of male sex by 0.01 microg/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 (beta=-0.04 microg/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). CONCLUSION DHEAS change continues into very old age, is not homogenous, is affected by sex, and is associated with prevalent CVD. Future studies should investigate factors that might accelerate DHEAS decline.
Collapse
Affiliation(s)
- Jason L Sanders
- Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | | | | | | | | | | | | |
Collapse
|