Serum DHEA-S level is associated with the presence of atherosclerosis in postmenopausal women with type 2 diabetes mellitus

Diabetes Mellitus Should Be Considered While Analysing Sarcopenia-Related Biomarkers

Sarcopenia is a chronic, progressive skeletal muscle disease characterised by low muscle strength and quantity or quality, leading to low physical performance. Patients with type 2 diabetes mellitus (T2DM) are more at risk of sarcopenia than euglycemic individuals. Because of several shared pathways between the two diseases, sarcopenia is also a risk factor for developing T2DM in older patients. Various biomarkers are under investigation as potentially valuable for sarcopenia diagnosis and treatment monitoring. Biomarkers related to sarcopenia can be divided into markers evaluating musculoskeletal status (biomarkers specific to muscle mass, markers of the neuromuscular junction, or myokines) and markers assuming causal factors (adipokines, hormones, and inflammatory markers). This paper reviews the current knowledge about how diabetes and T2DM complications affect potential sarcopenia biomarker concentrations. This review includes markers recently proposed by the expert group of the European Society for the Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) as those that may currently be useful in phase II and III clinical trials of sarcopenia: myostatin (MSTN); follistatin (FST); irisin; brain-derived neurotrophic factor (BDNF); procollagen type III N-terminal peptide (PIIINP; P3NP); sarcopenia index (serum creatinine to serum cystatin C ratio); adiponectin; leptin; insulin-like growth factor-1 (IGF-1); dehydroepiandrosterone sulphate (DHEAS); C-reactive protein (CRP); interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α). A better understanding of factors influencing these biomarkers' levels, including diabetes and diabetic complications, may lead to designing future studies and implementing results in clinical practice.

Circulating sex hormones and risk of atrial fibrillation: A systematic review and meta-analysis

BACKGROUND

Sex hormones are associated with many cardiovascular risk factors, but their effects on atrial fibrillation (AF) incidence remain unclear. This systematic review and meta-analysis aimed to evaluate the association of circulating sex hormones with AF risk by pooling available data from observational studies.

METHODS

A systematic literature search for pertinent articles with case-control and cohort designs was conducted via five databases up to 7 July 2021. A meta-analysis with six cohort studies was conducted separately on men and women. Adjusted relative risk (RR) with a 95% confidence interval (CI) was derived by comparing the highest with the lowest levels of a specific sex hormone and by using a random-effect or fixed-effect model. Heterogeneity was tested using the I ² statistic and the Q-test.

RESULTS

A total of six cohort studies and four case-control studies were included. In a meta-analysis of cohort studies, dehydroepiandrosterone sulfate (DHEAS) was associated with a decreased risk of AF in men (RR: 0.729, 95% CI: 0.559-0.952, I ² = 50.0%, P _{-heterogeneity} = 0.157) after combining results from two cohort studies; total testosterone was not associated with any risk of AF in men and postmenopausal women, and AF risk was not associated with estradiol in men after synthesizing available studies.

CONCLUSION

This study indicates that a higher endogenous DHEAS level was associated with a lower AF risk in men, whereas total testosterone and estradiol were not associated with AF risk. Longitudinal studies with multiple monitoring are needed to further promulgate the relationship between various circulating sex hormones and AF risk.

The correlation of salivary telomere length and single nucleotide polymorphisms of the ADIPOQ, SIRT1 and FOXO3A genes with lifestyle-related diseases in a Japanese population

Background

It has been reported that genetic factors are associated with risk factors and onset of lifestyle-related diseases, but this finding is still the subject of much debate.

Objective

The aim of the present study was to investigate the correlation of genetic factors, including salivary telomere length and three single nucleotide polymorphisms (SNPs) that may influence lifestyle-related diseases, with lifestyle-related diseases themselves.

Methods

In one year at a single facility, relative telomere length and SNPs were determined by using monochrome multiplex quantitative polymerase chain reaction and TaqMan SNP Genotyping Assays, respectively, and were compared with lifestyle-related diseases in 120 Japanese individuals near our university.

Results

In men and all participants, age was inversely correlated with relative telomere length with respective p values of 0.049 and 0.034. In men, the frequency of hypertension was significantly higher in the short relative telomere length group than in the long group with unadjusted p value of 0.039, and the difference in the frequency of hypertension between the two groups was of borderline statistical significance after adjustment for age (p = 0.057). Furthermore, in men and all participants, the sum of the number of affected lifestyle-related diseases, including hypertension, was significantly higher in the short relative telomere length group than in the long group, with p values of 0.004 and 0.029, respectively. For ADIPOQ rs1501299, men’s ankle brachial index was higher in the T/T genotype than in the G/G and G/T genotypes, with p values of 0.001 and 0.000, respectively. For SIRT1 rs7895833, men’s body mass index and waist circumference and all participants’ brachial-ankle pulse wave velocity were higher in the A/G genotype than in the G/G genotype, with respective p values of 0.048, 0.032 and 0.035. For FOXO3A rs2802292, women’s body temperature and all participants’ saturation of peripheral oxygen were lower in the G/T genotype than in the T/T genotype, with respective p values of 0.039 and 0.032. However, relative telomere length was not associated with physiological or anthropometric measurements except for height in men (p = 0.016). ADIPOQ rs1501299 in men, but not the other two SNPs, was significantly associated with the sum of the number of affected lifestyle-related diseases (p = 0.013), by genotype. For each SNPs, there was no significant difference in the frequency of hypertension or relative telomere length by genotype.

Conclusion

Relative telomere length and the three types of SNPs determined using saliva have been shown to be differentially associated with onset of and measured risk factors for lifestyle-related diseases consisting mainly of cardiovascular diseases and cancer.

Involvement of serum dehydroepiandrosterone sulfate in erythropoietic activity

PURPOSE

The aim of the present study was to determine how age-related decreases in serum dehydroepiandrosterone sulfate (DHEAS) levels affect various physiological processes.

METHODS

We retrospectively reviewed the medical records of patients in whom serum DHEAS levels were measured in our department and assessed the relationships between serum DHEAS levels and various patient characteristics.

RESULTS

Among the 149 patients included in our analysis (mean age: 52.7 ± 17.6 years, range: 15-84 years), 54 (36.2%) were men. Serum DHEAS levels inversely correlated with age in men (R = -0.810, p < .01) and to a lesser extent in women (R = -0.391, p < .01). Of note, there were significant positive associations between DHEAS levels and hemoglobin (R = 0.317, p ≤ .01) and hematocrit (R = 0.324, p ≤ .01) levels, which were observed in men, but not in women.

CONCLUSIONS

Our study suggests that reduced DHEAS secretion inhibits erythropoietic activity in aging men, perhaps owing to the erythropoietic androgenic actions of DHEAS. Importantly, it suggests that the age-associated decline in DHEAS secretion might decrease erythropoietic activity in aging men. It is also possible that the adrenal cortex, the source of DHEAS, is dysfunctional in anemic men.

Nerve conduction velocity is negatively associated with intima-media thickness and brachial-ankle pulse wave velocity in men with type 2 diabetes mellitus

Objective

Previous studies suggest that the presence of diabetic peripheral polyneuropathy (DPN) is associated with atherosclerotic diseases; however, little is known about the relationship between diabetic nerve conduction velocity (NCV) versus arterial stiffness and atherosclerosis parameters.

Methods

The subjects in this study were 292 men with type 2 diabetes mellitus (T2DM). All subjects underwent NCV examination at median and tibial nerves as motor nerve (MCV) as well as median and sural nerves as sensory nerve (SCV). Brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) were evaluated as arterial stiffness and atherosclerosis parameters.

Results

Pearson’s correlation coefficient showed that NCV at all sites negatively correlated with baPWV, maximal and mean IMT (IMT-Max and IMT-Mean), and plaque score (all p values p<0.01 at least). Multiple regression analyses adjusted for confounding factors such as age, duration of diabetes, body mass index, HbA1c, fasting C-peptide, systolic blood pressure, HDL-cholesterol, LDL-cholesterol and albuminuria showed that the association of NCV with IMT-Max, ITM-Mean, and plaque score remained significant (all p values p<0.05 at least) except that between SCV at median and IMT-Max. Moreover, SCV at median (forearm) and sural were significantly associated with baPWV (p = 0.023 and p = 0.027, respectively).

Conclusion

The present study showed that DPN estimated by quantitative NCV is linearly associated with the deterioration of arterial stiffness and atherosclerosis parameters in T2DM independently of various diabetic and atherosclerotic factors.

Reduced muscle mass and accumulation of visceral fat are independently associated with increased arterial stiffness in postmenopausal women with type 2 diabetes mellitus

BACKGROUND

Several studies showed that sarcopenia and visceral obesity are associated with arterial stiffness. Thus, their coexistence may be a crucial risk factor of arteriosclerosis. However, little is known about the cross relationships among muscle mass, visceral fat mass, and arterial stiffness in type 2 diabetes mellitus (T2DM).

METHODS

We recruited 97 postmenopausal women with T2DM and examine the association of muscle mass and visceral fat mass with brachial-ankle pulse wave velocity (baPWV). Relative skeletal muscle mass index (RSMI) and %trunk fat were evaluated by whole body dual-energy X-ray absorptiometry. Subcutaneous and visceral fat areas were measured by computed tomography.

RESULTS

Multiple regression analyses adjusted for age, duration of T2DM, systolic blood pressure, body mass index, HbA1c, serum creatinine, low-density lipoprotein-cholesterol, uric acid, and the usage of anti-hypertensive drug showed that RSMI was negatively associated with baPWV (β=-0.40, p=0.027), while %trunk fat and visceral fat area were positively associated with it (β=0.29, p=0.004 and β=0.51, p=0.001, respectively). Moreover, after additional adjustment for RSMI, %trunk fat and visceral fat area were positively associated with baPWV (β=0.26, p=0.010 and β=0.46, p=0.003, respectively) although the association between RSMI and baPWV became marginal after additional adjustment for %trunk fat or visceral fat area (β=-0.30, p=0.146 and β=-0.30, p=0.085, respectively).

CONCLUSIONS

Reduced muscle mass and increased visceral fat are independently associated with increased arterial stiffness in postmenopausal women with T2DM.

Regulation of local steroidogenesis in the brain and in prostate cancer: lessons learned from interdisciplinary collaboration

Sex steroids play critical roles in the regulation of the brain and many other organs. Traditionally, researchers have focused on sex steroid signaling that involves travel from the gonads via the circulation to intracellular receptors in target tissues. This classic concept has been challenged, however, by the growing number of cases in which steroids are synthesized locally and act locally within diverse tissues. For example, the brain and prostate carcinoma were previously considered targets of gonadal sex steroids, but under certain circumstances, these tissues can upregulate their steroidogenic potential, particularly when circulating sex steroid concentrations are low. We review some of the similarities and differences between local sex steroid synthesis in the brain and prostate cancer. We also share five lessons that we have learned during the course of our interdisciplinary collaboration, which brought together neuroendocrinologists and cancer biologists. These lessons have important implications for future research in both fields.

Dehydroepiandrosterone sulfate levels and risk of atrial fibrillation: the Rotterdam Study

BACKGROUND

High plasma dehydroepiandrosterone sulfate (DHEAS) levels have been associated with a reduced risk of cardiovascular disease and atherosclerosis. To our knowledge, no previous follow-up study has investigated the association between DHEAS and the development of atrial fibrillation. Our objective was to investigate the association between DHEAS levels and incident atrial fibrillation.

METHODS AND RESULTS

The study was based on a random sample within the prospective population-based Rotterdam Study. The study population comprised 1180 participants without atrial fibrillation at baseline for whom baseline levels of DHEAS were measured in plasma. Atrial fibrillation was ascertained from centre visit electrocardiogram (ECG) assessments as well as medical records. During a mean follow-up period of 12.3 years, 129 participants developed atrial fibrillation. DHEAS levels were inversely associated with the risk of atrial fibrillation (hazard ratio (HR) per standard deviation (SD): 0.74, 95% confidence interval (CI): 0.58-0.94). Subjects in the highest DHEAS quartile had an almost three times lower risk of atrial fibrillation during follow-up, compared to those in the lowest DHEAS quartile (HR: 0.34, 95% CI: 0.18-0.64) adjusted for age, sex and cardiovascular risk factors.

CONCLUSION

DHEAS can be regarded as an important indicator of future atrial fibrillation in both men and women, independent of known cardiovascular risk factors.

Effects of cigarette smoking, metabolic syndrome and dehydroepiandrosterone deficiency on intima-media thickness and endothelial function in hypertensive postmenopausal women

Background

Cigarette smoking is a major risk factor of atherosclerosis. The aim of this study was to assess the relationship between smoking and arterial hypertension as well as endothelial dysfunction in postmenopausal women without clinically manifested symptoms of atherosclerosis.

Material/Methods

The study groups consisted of 35 current smokers and 45 nonsmokers. The thickness of intima-media complex (IMT), a marker of atherosclerosis, was measured in carotid arteries. Plasma concentrations of fasting glucose, insulin, lipoproteins, inflammatory markers (tumor necrosis factor-alpha, intercellular adhesion molecule-1), matrix metalloproteinases (metalloproteinase-9, tissue inhibitor of metalloproteinase-1), insulin, and dehydroepiandrosterone sulfate (DHEA-S) were measured.

Results

Smokers compared with nonsmokers showed lower fasting glucose levels in blood (87.0±10.9 and 93.2±13.6 mg/dl, p<0.05), higher mean systolic (131.1±15.9 vs. 123.0±10.9 mm Hg, p<0.05) and diastolic (81.7±11.4 vs. 75.2±9.2 mm Hg, p<0.05) blood pressure during daytime, and higher average heart rate during the daytime (78.2±9.3/min vs. 71.5±9.5/min, p<0.01) and at night (67.2±10.6/min vs. 61.7±7.7/min, p<0.05), respectively. The IMT in the right carotid artery was significantly higher in smokers than in nonsmokers (0.96±0.16 mm vs. 0.82±0.21, p<0.05) and was positively correlated with smoking intensity (R=0.36) and habit duration (R=0.35). The comparison of inflammatory markers, metalloproteinases, and DHEA-S concentrations in plasma did not reveal significant differences between the 2 groups. A significant negative correlation between DHEA-S concentration in plasma and IMT in right carotid artery was found in smokers.

Conclusions

Smoking in hypertensive postmenopausal women is associated with lower fasting blood glucose and BMI values, but higher arterial pressure and heart rate, and increases in IMT in right carotid artery.

Effects of intensive glycemic control on serum levels of insulin-like growth factor-I and dehydroepiandrosterone sulfate in Type 2 diabetes mellitus

BACKGROUND

Although accumulating evidence shows that aging hormones are involved in glucose metabolism, effects of glycemic control on serum IGF-I and DHEAS levels are still unclear.

OBJECTIVE AND METHODS

To investigate the effects of glycemic control on these hormone levels, we conducted a 1-month longitudinal study of 49 Japanese patients with Type 2 diabetes mellitus. We measured serum levels of IGF-I and DHEA-S before and after 1-month glycemic control and analyzed the association of changes in IGF-I and DHEA-S with glycated hemoglobin (HbA1c).

RESULTS

HbA1c was decreased at 1 month with mean changes of -1.2% (p<0.001). Serum IGF-I was increased with mean changes of 11 ng/ml (p<0.05), while serum DHEA-S was decreased with mean changes of -19 μg/dl (p<0.05). Multiple regression analysis showed that changes in DHEA-S were inversely associated with changes in fasting plasma glucose (β=-0.36, p=0.027) and HbA1c (β=-0.33, p=0.028), while changes in IGF-I were not.

CONCLUSION

The present longitudinal study showed that intensive glycemic control for 1 month increased serum IGF-I level and decreased serum DHEA-S level in Japanese patients with poorly controlled Type 2 diabetes. Further studies are needed to clarify the hormonal changes in IGF-I and DHEA-S after intensive glycemic control would affect diabetic complications.

Serum insulin-like growth factor-I is negatively associated with serum adiponectin in type 2 diabetes mellitus

BACKGROUND

Although insulin-like growth factor-I (IGF-I) and dehydroepiandrosterone-sulfate (DHEA-S) are involved in age-related diseases such as cardiovascular disease and diabetes mellitus, the association of these hormones with serum adiponectin level is still unclear.

OBJECTIVE AND METHODS

To investigate the association between serum IGF-I and DHEA-S versus adiponectin, we conducted a cross-sectional study of 348 Japanese men with type 2 diabetes mellitus and examined their relationships. Serum total adiponectin level was measured by an ELISA kit.

RESULTS

Simple correlation analysis showed that patients' age and duration of diabetes were negatively correlated with IGF-I and DHEA-S (p<0.01) and positively with adiponectin (p<0.01), while body mass index (BMI) was positively correlated with IGF-I and DHEA-S (p<0.001) and negatively with adiponectin (p<0.001). IGF-I was negatively correlated with adiponectin (r=-0.25, p<0.001) and DHEA-S was negatively correlated with adiponectin and HbA1c (r=-0.17, p=0.003 and r=-0.12, p=0.027, respectively). In multiple regression analysis adjusted for age, duration of diabetes, BMI, and serum creatinine, HbA1c was negatively associated with IGF-I and DHEA-S (β=-0.12, p=0.036 and β=-0.22, p<0.001, respectively). Adiponectin was negatively associated with IGF-I (β=-0.15, p=0.013), but not DHEA-S. Moreover, this association was still significant after additional adjustment for HbA1c (β=-0.18, p=0.005).

CONCLUSIONS

Present cross-sectional study for the first time showed a negative association of serum IGF-I with serum adiponectin in Japanese men with type 2 diabetes independent of age, duration of diabetes, BMI, renal function, and HbA1c.

Relationship between bone biochemical markers versus glucose/lipid metabolism and atherosclerosis; a longitudinal study in type 2 diabetes mellitus

AIM

Although accumulating evidence suggests that osteocalcin, which is secreted in circulation specifically from osteoblasts, is involved in glucose and lipid metabolism, it is unclear whether serum osteocalcin is associated with atherosclerosis parameter in humans.

SUBJECTS AND METHODS

We monitored chronological changes in bone turnover markers and a parameter of atherosclerosis, plaque score (PS), during glycemic control in Japanese patients with type 2 diabetes, and analyzed relationships among these parameters.

RESULTS

Multiple regression analysis showed that changes in osteocalcin were negatively correlated with changes in HbA(1c) (β = -0.38, p = 0.01). Baseline osteocalcin was negatively correlated with changes in triglycerides (β = -0.29, p = 0.03) and positively with changes in HDL-cholesterol (β = 0.31, p = 0.03), and that changes in osteocalcin were negatively correlated with baseline triglyceride (β = -0.35, p = 0.02). Changes in osteocalcin were positively correlated with baseline PS (β = 0.35, p = 0.01) and negatively with changes in PS (β = -0.30, p < 0.05) independent of other conventional risk factors of atherosclerosis.

CONCLUSION

These findings indicated the association between serum osteocalcin and glucose and lipid metabolism as well as an atherosclerosis parameter independently of other atherosclerosis-related risk factors in patients with type 2 diabetes, suggesting that osteocalcin is important for not only bone metabolism but also glucose and lipid metabolism as well as atherosclerosis.

Dehydroepiandrosterone sulfate and postmenopausal women

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.

Asymmetric dimethylarginine as a risk factor for cardiovascular disease in Japanese patients with type 2 diabetes mellitus

AIMS

Although asymmetric dimethylarginine (ADMA) is known to be involved in the developing process of cardiovascular diseases (CVD), little is known about the effects of ADMA on atherosclerosis in Asian patients with diabetes, who have the racial feature of lower body mass index (BMI) and decreased capacity of insulin secretion and sensitivity.

METHODS

We employed 55 Japanese patients with type 2 diabetes mellitus (mean age, 64·2 years; 56% men) in a 6-month-longitudinal study and 450 patients (mean age, 62·7 years; 56% men) in a cross-sectional study and examined the association of serum ADMA with atherosclerosis parameters [intima-media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV)] as well as with the presence of CVD.

RESULTS

In the longitudinal study, multiple regression analysis showed that basal serum ADMA level had a significantly positive association with changes in IMT (β=0·35, P=0·03) independently of age, duration of diabetes, BMI, blood pressure, low-density lipoprotein and high-density lipoprotein (LDL and HDL) cholesterol, HbA(1c) , and renal function. In the cross-sectional study, the serum ADMA level was significantly and positively associated with the presence of CVD (odds ratio=7·22, 95% confidence interval 1·29-40·40, P=0·02, by logistic analysis) and with baPWV (β=0·14, P <0·01, by multiple regression analysis). In contrast, serum symmetric dimethylarginine level, a structural isomer of ADMA, was associated neither with parameters for atherosclerosis nor with the presence of CVD in both studies.

CONCLUSIONS

Serum ADMA is a predictor of atherosclerosis and associated with the presence of CVD in Japanese patients with type 2 diabetes mellitus.

Baseline atherosclerosis parameter could assess the risk of bone loss during pioglitazone treatment in type 2 diabetes mellitus

SUMMARY

We found that serum osteocalcin, femoral bone mineral density (F-BMD), and 1/3R-BMD were decreased during pioglitazone treatment in patients with type 2 diabetes. Moreover, baseline atherosclerosis parameter, serum insulin-like growth factor-I (IGF-I), and urinary N-terminal cross-linked telopeptide of type I collagen (uNTX) values were associated with changes in bone mineral density (BMD). Therefore, these parameters could assess the risk of BMD reduction in patients treated with pioglitazone.

INTRODUCTION

The aim of this study was to investigate the effects of pioglitazone or metformin on bone mass and atherosclerosis in patients with type 2 diabetes.

METHODS

A total of 55 Japanese patients were enrolled in this 1-year open-label study and randomized to either pioglitazone (n = 22, 15-30 mg/day) or metformin (n = 23, 500-750 mg/day) groups. BMD at the lumbar spine, femoral neck (F), and one third of the radius (1/3R), bone markers, and atherosclerosis parameters were measured.

RESULTS

In the pioglitazone group, serum osteocalcin significantly decreased at 6 months (p < 0.05), although it almost recovered to baseline level at 12 months. F-BMD significantly decreased at 6 months (p < 0.05), and 1/3R-BMD significantly decreased at 6 and 12 months (p < 0.05), while bone markers or BMD at any site were not changed in the metformin group. Although atherosclerosis parameters were not changed in the pioglitazone group, intima-media thickness (IMT)-mean significantly increased at 6 months (p < 0.05) and plaque score significantly increased at 6 and 12 months (p < 0.01) in the metformin group. In the pioglitazone group, %changes in F-BMD were significantly and negatively correlated with baseline IMT-Max, IMT-mean, and plaque scores (r = -0.61, p < 0.01; r = -0.71, p < 0.01; and r = -0.68, p < 0.01, respectively), and %changes in 1/3R-BMD were significantly and negatively correlated with baseline uNTX and IMT-Max (r = -0.57, p < 0.01 and r = -0.48, p < 0.05, respectively) and positively with IGF-I (r = 0.45, p < 0.05).

CONCLUSIONS

Baseline IMT, uNTX, and IGF-I could assess the risk of BMD reduction in diabetic patients treated with pioglitazone.

Protective effects of dehydroepiandrosterone on atherosclerosis in ovariectomized rabbits via alleviating inflammatory injury in endothelial cells

OBJECTIVE

The risk for atherosclerosis is increased in postmenopausal women. Dehydroepiandrosterone (DHEA) is postulated to have anti-atherogenic properties, but the mechanism remains unclear. The aim of this study was to elucidate the protective effect of DHEA on atherosclerosis in ovariectomized rabbits.

METHODS

The lipid status and atherosclerotic lesions were examined in vivo in ovariectomized rabbits. The effects of DHEA on expression of inflammatory molecules were evaluated in vitro, such as nitric oxide (NO), malondialdehyde (MDA), monocyte chemoattractant protein-1 (MCP-1), adhesion molecules (ICAM-1, VCAM-1 and E-selectin) in the human umbilical vein endothelial cells (HUVECs) injured by oxidized low-density lipoproteins (ox-LDL). The adhesion of the monocytic U937 cells to HUVECs was treated with supernatants of ox-LDL treated HUVECs with or without DHEA, and then the expressions of CCR2, LFA-1, VLA-4 were analyzed in U937 cells. The HUVECs with or without LPS treatment were then treated with DHEA, and NF-κB activity was measured by luciferase activity.

RESULTS

DHEA administration alleviates efficiently the early pathologic damage of atherosclerosis, increases the serum NO level, and up-regulates the endothelial cell estrogen receptor (ER) expression of ovariectomized rabbits. DHEA in vitro significantly promotes NO synthesis, suppresses MDA and MCP-1 secretion of endothelial cells, and decreases ICAM-1, VCAM-1 and E-selectin expression in HUVECs; neither selective ERα antagonist (methyl-piperidino-pyrazole, MPP) nor ERβ antagonist (R,R-tetrahydrochrysene, R,RTHC) can abolish these effects. Furthermore, DHEA reduces CCR2, LFA-1 and VLA-4 expression in U937 cells, which in turn inhibits the adherence of monocytes to the injured endothelial cells. DHEA significantly decreased the LPS-induced NF-κB transcription.

CONCLUSIONS

Our findings suggest that DHEA can alleviate inflammation in endothelial cells. The effects of DHEA on endothelial cells are independent of ERα or ERβ pathway, but at least in part, through suppression of NF-κB activity, which protects from atherosclerosis triggered by monocyte adherence.

Effects of treatment with risedronate and alfacalcidol on progression of atherosclerosis in postmenopausal women with type 2 diabetes mellitus accompanied with osteoporosis

INTRODUCTION

Accumulating evidence suggests that osteoporosis and cardiovascular disease have epidemiologic similarities. This study investigated the effects of treatment with risedronate and alfacalcidol on parameters of atherosclerosis in postmenopausal women with type 2 diabetes accompanied with osteoporosis.

METHODS

Thirteen Japanese type 2 diabetes postmenopausal women with newly diagnosed osteoporosis (osteoporosis group) and 13 age- and weight-matched diabetic women with normal bone mineral density (control group) were enrolled in this 1-year prospective study. Risedronate (2.5 mg/d) and alfacalcidol (1 microg/d) were given to the osteoporosis group for a year. We measured parameters of atherosclerosis, such as ultrasonographically evaluated plaque score (PS) and abdominal aortic calcification score (AACS) calibrated by x-ray.

RESULTS

Patients with osteoporosis had significantly higher PS and AACS than control [mean (range)-PS: 11.85 (0.00-27.50) versus 4.90 (0.00-10.90), P = 0.02 and AACS: 4.0 (0.0-14.0) versus 1.0 (0.0-7.0), P = 0.01]. After 1-year treatment, PS and AACS in the osteoporosis group were not statistically changed, whereas both parameters in the control group were significantly increased (P = 0.01 and P = 0.03, respectively). When percent changes in these parameters were compared between 2 groups, they were significantly different at any time points (at least P < 0.05).

CONCLUSIONS

Atherosclerosis parameters in diabetic patients with osteoporosis were higher than those in patients without it. Combination therapy of risedronate with alfacalcidol might protect against progressive atherosclerosis.

Associations between components of the metabolic syndrome versus bone mineral density and vertebral fractures in patients with type 2 diabetes

The association of bone with the metabolic syndrome and its features, visceral fat accumulation or insulin resistance, remains unclear. We determined visceral and subcutaneous fat areas (V and S) by computed tomography on 187 men (28-83 years) and 125 postmenopausal women (46-82 years) with type 2 diabetes. Men whose V was 100 cm(2) or more had significantly lower urinary N-terminal cross-linked telopeptide of type-I collagen (p=0.005), higher femoral neck bone mineral density (FN-BMD) (p=0.004), and lower prevalence of vertebral fractures (VFs) (p=0.04) than controls. Fat mass, V, S, and lean body mass positively correlated with FN-BMD in men and with lumbar (L) and FN-BMD in women. When adjusted for weight, these correlations became negative. Urinary C-peptide positively correlated with FN-BMD in both genders. Multivariate logistic regression analysis adjusted for age, height, weight, L-BMD, duration of diabetes, and diabetes therapies identified V in men and urinary C-peptide in women as factors inversely associated with the presence of VFs [odds ratio (OR)=0.61 per SD increase, p=0.04, and OR=0.32, p=0.01, respectively]. These findings suggest that, of the components of the metabolic syndrome, body fat in gravity and hyperinsulinemia could increase FN-BMD in diabetic subjects. Visceral fat in men and hyperinsulinemia in women may protect against VFs independent of weight, L-BMD, diabetes duration, or therapies.

Serum osteocalcin level is associated with glucose metabolism and atherosclerosis parameters in type 2 diabetes mellitus

CONTEXT

Recent animal studies showed that osteocalcin action is related to not only bone metabolism but also glucose metabolism and fat mass. We investigated the relationship between two bone formation markers, serum osteocalcin and bone-specific alkaline phosphatase, and glucose metabolism, serum adiponectin, and the amount of fat mass as well as atherosclerosis parameters in men and postmenopausal women with type 2 diabetes.

METHODS

A total of 179 men and 149 postmenopausal women were recruited consecutively, and radiographic and biochemical characteristics were collected. Brachial-ankle pulse wave velocity (baPWV) and intima-media thickness (IMT) were evaluated as the parameters of atherosclerosis.

RESULTS

Multiple regression analysis adjusted for age, duration of diabetes, body mass index, and serum creatinine showed that osteocalcin negatively correlated with fasting plasma glucose and hemoglobin A(1c) in both men and postmenopausal women (P < 0.05) and with percent fat, baPWV, and IMT in men (P < 0.05). Osteocalcin positively correlated with total adiponectin in postmenopausal women (P < 0.001). After additional adjustments for systolic blood pressure, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, hemoglobin A(1c), and Brinkmann index, osteocalcin still significantly and negatively correlated with baPWV and IMT in men. In contrast, osteocalcin did not correlate with fasting C-peptide, and bone-specific alkaline phosphatase did not correlate with any variable in either men or postmenopausal women.

CONCLUSIONS

Serum osteocalcin is associated with glucose and total adiponectin levels, fat mass, and atherosclerosis parameters in patients with type 2 diabetes, suggesting that osteocalcin is important for not only bone metabolism but also glucose and fat metabolism.