Prospective measurements of dehydroepiandrosterone sulfate in a cohort of elderly subjects: relationship to gender, subjective health, smoking habits, and 10-year mortality.
ABSTRACT The decrease with age of the adrenal-secreted dehydroepiandrosterone sulfate (DHEAS) in serum has suggested that it may be causally related to longevity. For the PAQUID [People (Personnes) Aged (Agées) About What (Quid, in Latin)] cohort of elderly subjects, we have previously reported higher DHEAS in men than in women, a decrease with age and, among men, a negative correlation between the DHEAS level and mortality at 2 and 4 years. Here, with an 8-year followup in 290 subjects, we show a global decrease of 2.3% per year for men and 3.9% per year for women. However, in approximately 30% of cases, there was an increase of DHEAS. We observed no relationship between the evolution of DHEAS level and functional, psychological, and mental status, possibly because of selection by death. In women, no association was found between mortality and DHEAS level. In men, the relative risk (RR) of death was higher for the lowest levels of DHEAS (RR = 1.9, P = 0.007), with RR = 6.5, P = 0.003 for those under 70 years old, a result indicating heterogeneity of the population. There was an effect of subjective health on mortality that disappeared after adjustment of DHEAS levels, suggesting its relation with these DHEAS levels. Death RR was much higher in smokers with a low DHEAS level than in nonsmokers with high DHEAS (RR = 6.7, P = 0.001). We submit that the involvement of DHEAS is possibly different according to gender, that association between low DHEAS level and mortality only for men under 70 years old possibly reflects heterogeneity of the population, and that DHEAS level is a reliable predictor of death in male smokers.
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ABSTRACT: The construct validity and ability to predict mortality on the basis of 4 British Medical Research Council (BMRC) questions on breathlessness were examined and compared to that of spirometric measurements, in particular FEV1, in a cohort of 1,045 men. Of these, 1,030 answered questions on breathlessness and 994 performed acceptable spirometry. Using 2 levels of dyspnea, white collar workers had significantly fewer symptoms of breathlessness than both cement workers and other blue collar workers, and this effect was present even after controlling for FEV1 as well as other spirometric measurements. We found an effect of age on dyspnea but not of smoking category. Furthermore, questions on breathlessness showed a dependence on extreme overweight. In a 10-yr follow-up, 219 men had died. Dyspnea Grade 3 or worse according to Fletcher's breathlessness score was a good predictor of overall mortality, yielding a mortality ratio of 1.57 for given occupation, smoking category, years with central heating, and overweight status, after controlling for FEV1. We conclude that in a standardized setting, questions on breathlessness provide a sensitive and objective tool. They contain information additional to that provided by FEV1 and other spirometric measurements.The American review of respiratory disease 06/1988; 137(5):1114-8. · 10.19 Impact Factor
Recent Progress in Hormone Research 02/1963; 19:275-310.
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ABSTRACT: An antiestrogenic effect of cigarette smoking has been suggested, principally on the basis of data on premenopausal women. We examined the relation between cigarette smoking and endogenous sex-hormone levels in a population of 233 white, postmenopausal women 60 to 79 years of age. Current cigarette smokers had significantly higher mean plasma levels of the adrenal androgens dehydroepiandrosterone sulfate and androstenedione than nonsmokers. Mean levels for smokers and nonsmokers were 3.1 mumol per liter (116 micrograms per deciliter) and 2.3 mumol per liter (86 micrograms per deciliter), respectively (P less than 0.001), for dehydroepiandrosterone sulfate, and 27.8 nmol per liter (797 pg per milliliter) and 22.5 nmol per liter (643 pg per milliliter), respectively (P = 0.002), for androstenedione. A dose-response relation was apparent for these hormones; mean plasma levels increased concomitantly with cigarette consumption. The differences in hormone levels remained after adjustment for age and body-mass index. Mean levels of estrone, estradiol, testosterone, and sex-hormone-binding globulin did not differ between smokers and nonsmokers. These results suggest that the possible decreased risk of breast and endometrial cancer associated with cigarette smoking may not be mediated through lower levels of endogenous estrogen, at least in postmenopausal women, and they raise questions about the role of androgens in disease mechanisms in older populations.New England Journal of Medicine 07/1988; 318(26):1705-9. · 53.30 Impact Factor