@article{4b4e3ea3502547489128fac2f44dda17,
title = "Lower DHEA-S levels predict disease and worse outcomes in post-menopausal women with idiopathic, connective tissue disease- And congenital heart diseaseassociated pulmonary arterial hypertension",
abstract = "High oestradiol (E2) and low dehydroepiandrosterone-sulfate (DHEA-S) levels are risk factors for pulmonary arterial hypertension (PAH) in men, but whether sex hormones are related to PAH in women is unknown. Post-menopausal women aged .55 years with PAH were matched by age and body mass index to women without cardiovascular disease. Plasma sex hormone levels were measured by immunoassay. Lower levels of DHEA-S (p<0.001) and higher levels of E2 (p=0.02) were associated with PAH. In PAH cases (n=112), lower DHEA-S levels were associated with worse haemodynamics (all p<0.01) and more right ventricular dilatation and dysfunction (both p=0.001). Lower DHEA-S levels were associated with shorter 6-min walking distance (6MWD) (p=0.01) and worse functional class (p=0.004). Each Ln(1 μg·dL-1) decrease in DHEA-S was associated with a doubling in the risk of death (hazard ratio 2.0, 95% CI 1.5-2.7; p<0.001). Higher levels of E2 were associated with shorter 6MWD (p=0.03) and worse functional class (p=0.01). High E2 and low DHEA-S levels are associated with the risk and severity of PAH in post-menopausal women. Hormonal modulation should be studied as a treatment strategy in PAH.",
author = "Baird, {Grayson L.} and Christine Archer-Chicko and Barr, {R. Graham} and Bluemke, {David A.} and Foderaro, {Andrew E.} and Fritz, {Jason S.} and Hill, {Nicholas S.} and Kawut, {Steven M.} and Klinger, {James R.} and Lima, {Joao A.C.} and Mullin, {Christopher J.} and Pamela Ouyang and Palevsky, {Harold I.} and Palmisicano, {Amy J.} and Diane Pinder and Preston, {Ioana R.} and Roberts, {Kari E.} and Smith, {K. Akaya} and Thomas Walsh and Mary Whittenhall and Ventetuolo, {Corey E.}",
note = "Funding Information: Acknowledgements: This manuscript has been reviewed by all investigators for scientific content and consistency of data interpretation with previous MESA publications. Significant comments have been incorporated prior to submission for publication. The authors thank the other investigators, the staff, PAH patients and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at www. mesa-nhlbi.org Conflict of interest: S.M. Kawut reports grants (for research and CME) from Actelion, United Therapeutics, Gilead, Lung Biotech, Bayer and the Cardiovascular Medical Research and Education Fund, and personal fees (for travel) from the American Thoracic Society, outside the submitted work. J.R. Klinger reports grants from Actelion, United Therapeutics, Gilead, Eiger and Bayer, outside the submitted work. H.I. Palevsky reports personal fees from Actelion, Janssen, Bayer, GSK and United Therapeutics, outside the submitted work. I.R. Preston reports grants and personal fees from Actelion, grants from Bayer and Gilead, and personal fees from Arena, United Therapeutics and Pfizer, outside the submitted work. A. Smith reports grants from Actelion, Gilead and United Therapeutics, outside the submitted work. M. Whittenhall reports personal fees from Actelion, Bayer, Gilead and United Therapeutics, outside the submitted work. C.E. Ventetuolo reports personal fees from Bayer, Acceleron and United Therapeutics and grants from the CHEST Foundation (Actelion sponsored) and Eiger paid to her institution, outside the submitted work. C. Archer-Chicko reports personal fees from Actelion, outside the submitted work. Funding Information: Support statement: This work was completed with support from an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health (P20 GM103652), 11FTF7400032 from the American Heart Association, and K24-HL103844 from the National Heart, Lung, and Blood Institute. Support for MESA is provided by contracts R01-HL086719, R01-HL077612, HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079 and UL1-TR-001420 from the National Center for Advancing Translational Sciences. Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: {\textcopyright} ERS 2018. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.",
year = "2018",
doi = "10.1183/13993003.00467-2018",
language = "English (US)",
volume = "51",
journal = "European Respiratory Journal, Supplement",
issn = "0903-1936",
publisher = "European Respiratory Society",
number = "6",
}