Adrenal androgens and testosterone as coronary risk factors in the Helsinki Heart Study

Abstract

We investigated the role of adrenal androgens, cortisol, testosterone and sex-hormone binding globulin (SHBG) as coronary risk factors using a nested case-control design. The study population consisted of 62 cases with cardiac endpoints and 97 controls on placebo during the last 4 years in the Helsinki Heart Study. Serum concentrations of dehydroepiandrosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, androstanediol glucuronide, cortisol, testosterone, and SHBG at the first annual visit of the 5-year study period were determined by radioimmunoassays. The only significant difference was found in DHEAS, with cases having higher levels than controls ( P < 0.04). DHEAS levels were positively associated with smoking ( P < 0.001), alcohol consumption ( P < 0.04) and triglyceride levels ( P < 0.002) and with systolic ( P < 0.04) and diastolic ( P < 0.006) blood pressures, and negatively associated with age ( P < 0.01) and HDL-cholesterol ( P < 0.03). The association between DHEAS and the CHD risk was studied using logistic regression analyses with the classical risk factors - age, smoking, blood pressure, and lipid levels — as covariates in the models. Studies of the joint effects of age and DHEAS disclosed that the risk associated with elevated DHEAS was confined to older men (odds ratio (OR) 7.3, 95% CI 2.3–23.3). A similar analysis with smoking revealed that the DHEAS-related risk was mainly found in smokers (OR 3.4, 95% CI 1.5–8.2). One possible explanation for these results is that some form of mild steroid biosynthetic defect of the adrenals or functional adrenal hyperplasia associated with high DHEAS levels increases the CHD risk in this population.