Waimei Tai, MD

  • A large observational nested case-control study by Jimenez et. al. using collected data from the Nurses Health Study demonstrated decreased dehydroepiadrosterone sulfate (DHEAS) in women who have an ischemic stroke during the >10 year follow up period. 

    DHEAS is the major precursor for 50% of androgens in men, 75% of estrogens in premenopausal women, and almost 100% of estogrens in postmenopausal women. Low DHEAS level has been previously associated with increased incidence of ischemic heart disease.  

    In this study, the lowest quartile of DHEAS was associated with being older, less educated, higher prevalence of hypertension, high cholesterol, history of heart disease, and higher proportion of hormone therapy use. However, after adjusting for matching risk factors, women in the lowest quartile of DHEAS versus the highest quartile of DHEAS had a non-significant increased risk for ischemic stroke.

    The authors propose that a novel association with a stable hormonal biomarker with increased ischemic stroke risk. Whether this is merely an association and a risk marker of underlying vascular disease, or a causative factor in ischemic stroke, be it directly or through its downstream androgenic/estrogenic activity, is unclear.

    I think this is an interesting study, as it potentially proposes new markers of disease that may not have been previously studied. As the authors’ point out, this initial study may suggest other new research questions. Much work in the neuro-hormonal arena has been focused on how hormones act as neuro-transmitters, or interact in the brain’s chemical milieu. Now potentially new directions of research can look at how hormones act on cerebral vessels, or neuronal activity and recovery.