Koroner Arter Hastalığı Olan Erkek Hastalarda Kollateral Dolaşımın Derecesi İle Testosteron ve Dehidroepiandrosteronun Seviyesi Arasındaki İlişkinin Değerlendirilmesi
Synopsis
Giriş ve Amaç: Koroner kollateral dolaşım (KKD), koroner perfüzyonun bozulduğu ciddi koroner darlıklarda aktive olan, perfüzyonu devam ettirmeye çalışan vasküler kanallardan oluşur. Gelişmiş kollateraller kardiyak iskemiyi azaltarak morbidite ve mortalitede azalmayı sağlar. Birçok çalışma koroner kollateral gelişimini etkileyen etkenler araştırılarak, kötü kolateral gelişimini önlemeyi amaçlamıştır. Biz de bu çalışmada, KKD gelişimi ile erkek sex steroidleri arasında ilişkiyi değerlendirmeyi amaçladık.
Metod: KKD ve epikardiyal koroner arterlerde ≥%95 darlık mevcut 50 hasta (30 iyi kollateral gelişimi olan, 20 kötü kollateral gelişimi olan) ayrıca koroner anjiyografi sonucu normal koronerler saptanan 22 birey çalışmaya dahil edildi. Kollateral derecelendirmesi Rentrop sınıflamasına göre yapıldı. Rentrop 0-1 kollateral gelişimi kötü kollateral, Rentrop 2-3 kollateral gelişimi iyi kollateral gelişimi olarak sınıflandırıldı. Tüm katılımcıların serbest testosteron, DHEA, DHEAS, SHBG sonuçları ölçüldü. Ölçümler SPSS 23.0 paket programı kullanılarak değerlendrildi. Kategorik ve sürekli ölçümlerse Gruplara göre sürekli ölçümlerin karşılaştırılmasında dağılımlar kontrol edildi, parametrik test varsayımlarını sağlayan değişkenler için Student’ın T testi, parametrik test varsayımlarını sağlamayan değişkenlerde Mann Whitney U testi kullanıldı. Kategorik değişkenlerin karşılaştırılmasında Ki Kare test istatistiği kullanıldı. Tüm testlerde istatistiksel önem düzeyi p<0.05 olarak alındı.
Bulgular: Demografik ve temel ekokardiyografik özellikler bakımından üç grup arasında anlamlı farklılık bulunmadı (p>0,05). Kötü kollateral gelişimi olan grupta medyan serbest testosteron değeri 6,9 ng/dl, testosteron 293ng/dl, DHEA-S 104ug/dl, SHBG 29,2mol/l, iyi kollateral grupta medyan serbest testosteron değeri 6,7ng/dl, testosteron 320ng/dl, DHEA-S 153ug/dl SHBG 31,1nmol/l ,kontrol grubunda medyan serbest testosteron değeri 7,4 ng/dl , testosteron 297ng/dl, DHEA-S 132ug/dl ,SHBG 26,3nmol/l saptandı. Tüm testlerde istatistiksel olarak anlamlı bir fark izlenmedi.
Sonuç: Kollateral gelişimi ile sex steroidleri arasında anlamlı bir ilişki saptanmadı.
References
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Aytan Y, Koşar F, et al. Kollateral dolaşım. MN Kardiyoloji; 2007;7(1): 64-70.
Cohen M, Rentrop KP. Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation; 1986;74:469-76. doi:10.1161/01.CIR.74.3.469
Pogweizd SM, Corr PB. Mechanisms underlying the development of ventricular fibrillation during early myocardial ischemia. Circulation Research; 1990;67:772-82. doi:10.1161/01.RES.67.4.772
Newman PE. The coronary collateral circulation: determinants and functional significance in ischemic heart disease. American Heart Journal; 1981;102:431-45. doi:10.1016/0002-8703(81)90035-3
Van Royen N, Piek JJ, Schaper W, et al. Arteriogenesis: mechanisms and modulation of collateral artery development. Journal of Nuclear Cardiology; 2001;8:687-93. doi:10.1067/mnc.2001.118098
Payne AH, Hales DB. Overview of steroidogenic enzymes in the pathway from cholesterol to active steroid hormones. Endocrine Reviews; 2004;25(6):947-970. doi:10.1210/er.2003-0030
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Simpson ER, Davis SR. Minireview: Aromatase and the regulation of estrogen biosynthesis—some new perspectives. Endocrinology; 2001;142(11):4589-4594. doi:10.1210/endo.142.11.8481
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Wolkowitz OM, Reus VI, Roberts E. Dehydroepiandrosterone (DHEA) treatment of depression. Biological psychiatry;1997; 41(3), 311-318.
Chang DM, Lan JL, Lin HY, et al. Dehydroepiandrosterone treatment of women with mild-to-moderate systemic lupus erythematosus: A multicenter randomized, double-blind, placebo-controlled trial. Arthritis & Rheumatology; 2002;46(11):2924-2927. doi:10.1002/art.10538
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Baulieu EE, et al. Dehydroepiandrosterone (DHEA): A fountain of youth? Journal of Clinical Endocrinology & Metabolism; 1996;81(9):3147-3151. doi:10.1210/jcem.81.9.8784072
Morales AJ, Nolan JJ, Nelson JC, et al. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. Journal of Clinical Endocrinology & Metabolism; 1994;78(6):1360-1367. doi:10.1210/jcem.78.6.8200942
Miller WL, Auchus RJ. The molecular biology, biochemistry, and physiology of human steroidogenesis and its disorders. Endocrine Reviews; 2011;32(1):81-151. doi:10.1210/er.2010-0013
Wolf OT, Kirschbaum C. Actions of dehydroepiandrosterone and its sulfate in the central nervous system: Effects on cognition and emotion in animals and humans. Brain Research Reviews; 1999;30(3):264-288. doi:10.1016/S0165-0173(99)00020-3
Conley AJ, Bird IM. The role of cytochrome P450 17α-hydroxylase and 3β-hydroxysteroid dehydrogenase in the integration of gonadal adrenal steroidogenesis via the delta 5 and delta 4 pathways of steroidogenesis in mammals. Biology reproduction;1997;56(4):789-799. doi: 10.1095/bioreprod56.4.789
Ketan D, Bigelow ML, Sreekuma K.Effect of dehydroepiandrosterone replacement on insulin sensitivity and lipids in hypoadrenal women. Diabetes;2005; 54.3: 765-769.
Helzlsouer KJ, Gordon GB, Alberg AJ, et al. Relationship of prediagnostic serum levels of dehydroepiandrosterone and dehydroepiandrosterone sulfate to the risk of developing premenopausal breast cancer. Cancer research; 1192;52(1), 1-4.
Hazeldine J, Arlt W, Lord JM, et al. Dehydroepiandrosterone as a regulator of immune cell function. Journal of Steroid Biochemistry and Molecular Biology; 2010;120(2-3):127-136. doi:10.1016/j.jsbmb.2010.03.073
Villareal DT, Holloszy JO, et al. Effect of DHEA on abdominal fat and insulin action in elderly women and men: A randomized controlled trial. JAMA; 2000;284(17):2243-2248. doi:10.1001/jama.284.17.2243
Barrett-Connor E, Khaw KT, Yen SS, et al. A prospective study of dehydroepiandrosterone sulfate, mortality, and cardiovascular disease. New England Journal of Medicine; 1986;315(24):1519-1524. doi:10.1056/NEJM198612113152403
Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Circulation; 2002;106:3143. doi:10.1161/circ.106.25.3143
Rentrop KP, Thornton JC, Feit F, Karsch KR, et al. Determinants and protective potential of coronary collaterals in patients with coronary artery disease undergoing angioplasty. Journal of the American College of Cardiology; 1988;12(3):738-748. doi:10.1016/0735-1097(88)90416-2
Phillips GB, Pinkernell BH, Jing TY, et al. The association of hypotestosteronemia with coronary artery disease in men. Arteriosclerosis, Thrombosis, and Vascular Biology. 1994;14:701–706. doi:10.1161/01.ATV.14.5.701
Alexandersen P, Haarbo J, Christiansen C, et al. The relationship of natural androgens to coronary heart disease in males: A review. Atherosclerosis; 1996;125:1–13. doi:10.1016/0021-9150(96)05821-3
Hauner H, Stangl K, Burger K, et al. Sex hormone concentrations in men with angiographically assessed coronary artery disease: Relationship to obesity and body fat distribution. Klinische Wochenschrift; 1991;69:664–668. doi:10.1007/BF01648102
Van Pottelbergh I, Braeckman D, De Bacquer D, et al. Differential contribution of testosterone and estradiol in the determination of cholesterol and lipoprotein profile in healthy middle-aged men. Atherosclerosis; 2003;166:95–102. doi:10.1016/S0021-9150(02)00317-4
Tchernof A, Labrie F, Belanger A, et al. Relationships between endogenous steroid hormone, sex hormone-binding globulin and lipoprotein levels in men: Contribution of visceral obesity, insulin levels and other metabolic variables. Atherosclerosis; 1997;133:235–244. doi:10.1016/S0021-9150(97)00182-7
Haffner SM, Mykkanen L, Valdez RA, et al. Relationship of sex hormones to lipids and lipoproteins in nondiabetic men. Journal of Clinical Endocrinology & Metabolism; 1993;77:1610–1615. doi:10.1210/jcem.77.6.8263141
Sewdarsen M, Vythilingum S, Jialal I, et al. Abnormalities in sex hormones are a risk factor for premature manifestation of coronary artery disease in South African Indian men. Atherosclerosis; 1990;83:111–117. doi:10.1016/0021-9150(90)90090-2
Aksut SV, Aksut G, Karamehmetoglu A, et al. The determination of serum estradiol, testosterone and progesterone in acute myocardial infarction. Japanese Heart Journal; 1986;27:825–837. doi:10.1536/ihj.27.825
Khaw KT, Dowsett M, Folkerd E, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation;2007;116:2694–2701. doi:10.1161/CIRCULATIONAHA.107.719005
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Sieveking DP, Lim P, Chow RW, Dunn LL, et al. A sex-specific role for androgens in angiogenesis. Journal of Experimental Medicine; 2010;207(2):345-352. doi:10.1084/jem.20091924
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Sasayama S, Fujita M, et al. Recent insights into coronary collateral circulation. Circulation; 1992;85:1197-204. doi:10.1161/01.CIR.85.3.1197
Levin DC. Pathways and functional significance of the coronary collateral circulation. Circulation; 1974;50:831-7. doi:10.1161/01.CIR.50.4.831
Aytan Y, Koşar F, et al. Kollateral dolaşım. MN Kardiyoloji; 2007;7(1): 64-70.
Cohen M, Rentrop KP. Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation; 1986;74:469-76. doi:10.1161/01.CIR.74.3.469
Pogweizd SM, Corr PB. Mechanisms underlying the development of ventricular fibrillation during early myocardial ischemia. Circulation Research; 1990;67:772-82. doi:10.1161/01.RES.67.4.772
Newman PE. The coronary collateral circulation: determinants and functional significance in ischemic heart disease. American Heart Journal; 1981;102:431-45. doi:10.1016/0002-8703(81)90035-3
Van Royen N, Piek JJ, Schaper W, et al. Arteriogenesis: mechanisms and modulation of collateral artery development. Journal of Nuclear Cardiology; 2001;8:687-93. doi:10.1067/mnc.2001.118098
Payne AH, Hales DB. Overview of steroidogenic enzymes in the pathway from cholesterol to active steroid hormones. Endocrine Reviews; 2004;25(6):947-970. doi:10.1210/er.2003-0030
Nieschlag E, Behre HM. Testosterone: Action, deficiency, substitution; Cambridge University Press; 2004.
Heinlein CA, Chang C. Androgen receptor in prostate cancer. Endocrine Reviews; 2002;23(2):175-200. doi:10.1210/edrv.23.2.0461
Vermeulen A, Verdonck L, Kaufman JM, et al. A critical evaluation of simple methods for the estimation of free testosterone in serum. Journal of Clinical Endocrinology & Metabolism; 1999;84(10):3666-3672. doi:10.1210/jcem.84.10.6030
Vermeulen A, et al. Andropause. Maturitas: 2000;34(1):5-15. doi:10.1016/S0378-5122(00)00236-X
Davis SR, Tran J. Testosterone influences libido and well being in women. Trends in Endocrinology & Metabolism; 2001;12(1):33-37. doi:10.1016/S1043-2760(00)00343-7
Simpson ER, Davis SR. Minireview: Aromatase and the regulation of estrogen biosynthesis—some new perspectives. Endocrinology; 2001;142(11):4589-4594. doi:10.1210/endo.142.11.8481
Wilson JD. Role of dihydrotestosterone in androgen action. Prostate Supplement; 1996;6:88-92. doi:10.1002/pros.2990290304
Kumar R, Thompson EB.. Androgen and estrogen receptors: Structure and function. Journal of Clinical Oncology; 1999;17(5):1733-1745. doi:10.1200/JCO.1999.17.5.1733
Gorelick MH, Kuttesch JS. Androgen receptor gene mutations in male infertility: A review of the literature. Journal of Urology; 2001;165(3):795-801. doi:10.1097/00005392-200103000-00013
Matsumoto AM. Andropause: Clinical implications of the decline in serum testosterone levels with aging in men. Journals of Gerontology Series A: Biological Sciences and Medical Sciences; 2002;57(2) doi:10.1093/gerona/57.2.M76
Mooradian AD, Morley JE, Korenman SG, et al. Biological actions of androgens. Endocrine Reviews; 1987;8(1):1-28. doi:10.1210/edrv-8-1-1
Kuhn CM. Anabolic steroids. Recent Progress in Hormone Research; 2002;57:411-434. doi:10.1210/rp.57.1.411
Watson RR. DHEA in human health and aging. CRC Press;2011.
Khorram, Omid, Lan Vu, and Samuel SC Yen. Activation of immune function by dehydroepiandrosterone (DHEA) in age-advanced men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences;1997;52.1:1-7.
Hanan A, Metwally F, Ahmed H. Neuroprotective effects of dehydroepiandrosterone (DHEA) in rat model of Alzheimer's disease. Acta Biochimica Polonica ;2011;58.4: 513-520.
Maninger N, Wolkowitz OM, Reus VI, et al. Neurobiological and neuropsychiatric effects of dehydroepiandrosterone (DHEA) and DHEA-S. Frontiers in Neuroendocrinology; 2009;30(1):65-91. doi:10.1016/j.yfrne.2008.11.002
Hunt PJ, Gurnel EM, Hupper FA etal. Improvement of mood and fatigue after dehydroepiandrosterone replacement in Addison's disease in a randomized, double-blind trial. Journal of Clinical Endocrinology & Metabolism; 2000;85(12):4650-4656. doi:10.1210/jcem.84.2.5467
Wolkowitz OM, Reus VI, Roberts E. Dehydroepiandrosterone (DHEA) treatment of depression. Biological psychiatry;1997; 41(3), 311-318.
Chang DM, Lan JL, Lin HY, et al. Dehydroepiandrosterone treatment of women with mild-to-moderate systemic lupus erythematosus: A multicenter randomized, double-blind, placebo-controlled trial. Arthritis & Rheumatology; 2002;46(11):2924-2927. doi:10.1002/art.10538
Arlt W, Callies F, van Vlijmen JC, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. The New England Journal of Medicine;1999;341(14):1013-1020. doi:10.1056/NEJM199909303411404
Jankowski CM, Gozansky WS, Schwartz RS, et al. Effects of dehydroepiandrosterone replacement therapy on bone mineral density in older adults: a randomized, controlled trial. Journal of Clinical Endocrinology & Metabolism; 2006;91(8):2986-2993. doi:10.1210/jc.2005-2484
Zina B, Charru P, Lidy C.Dehydroepiandrosterone (DHEA) and aging. Archives of gerontology and geriatrics; 1997;24.3: 233-241.
Baulieu EE, et al. Dehydroepiandrosterone (DHEA): A fountain of youth? Journal of Clinical Endocrinology & Metabolism; 1996;81(9):3147-3151. doi:10.1210/jcem.81.9.8784072
Morales AJ, Nolan JJ, Nelson JC, et al. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. Journal of Clinical Endocrinology & Metabolism; 1994;78(6):1360-1367. doi:10.1210/jcem.78.6.8200942
Miller WL, Auchus RJ. The molecular biology, biochemistry, and physiology of human steroidogenesis and its disorders. Endocrine Reviews; 2011;32(1):81-151. doi:10.1210/er.2010-0013
Wolf OT, Kirschbaum C. Actions of dehydroepiandrosterone and its sulfate in the central nervous system: Effects on cognition and emotion in animals and humans. Brain Research Reviews; 1999;30(3):264-288. doi:10.1016/S0165-0173(99)00020-3
Conley AJ, Bird IM. The role of cytochrome P450 17α-hydroxylase and 3β-hydroxysteroid dehydrogenase in the integration of gonadal adrenal steroidogenesis via the delta 5 and delta 4 pathways of steroidogenesis in mammals. Biology reproduction;1997;56(4):789-799. doi: 10.1095/bioreprod56.4.789
Ketan D, Bigelow ML, Sreekuma K.Effect of dehydroepiandrosterone replacement on insulin sensitivity and lipids in hypoadrenal women. Diabetes;2005; 54.3: 765-769.
Helzlsouer KJ, Gordon GB, Alberg AJ, et al. Relationship of prediagnostic serum levels of dehydroepiandrosterone and dehydroepiandrosterone sulfate to the risk of developing premenopausal breast cancer. Cancer research; 1192;52(1), 1-4.
Hazeldine J, Arlt W, Lord JM, et al. Dehydroepiandrosterone as a regulator of immune cell function. Journal of Steroid Biochemistry and Molecular Biology; 2010;120(2-3):127-136. doi:10.1016/j.jsbmb.2010.03.073
Villareal DT, Holloszy JO, et al. Effect of DHEA on abdominal fat and insulin action in elderly women and men: A randomized controlled trial. JAMA; 2000;284(17):2243-2248. doi:10.1001/jama.284.17.2243
Barrett-Connor E, Khaw KT, Yen SS, et al. A prospective study of dehydroepiandrosterone sulfate, mortality, and cardiovascular disease. New England Journal of Medicine; 1986;315(24):1519-1524. doi:10.1056/NEJM198612113152403
Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Circulation; 2002;106:3143. doi:10.1161/circ.106.25.3143
Rentrop KP, Thornton JC, Feit F, Karsch KR, et al. Determinants and protective potential of coronary collaterals in patients with coronary artery disease undergoing angioplasty. Journal of the American College of Cardiology; 1988;12(3):738-748. doi:10.1016/0735-1097(88)90416-2
Phillips GB, Pinkernell BH, Jing TY, et al. The association of hypotestosteronemia with coronary artery disease in men. Arteriosclerosis, Thrombosis, and Vascular Biology. 1994;14:701–706. doi:10.1161/01.ATV.14.5.701
Alexandersen P, Haarbo J, Christiansen C, et al. The relationship of natural androgens to coronary heart disease in males: A review. Atherosclerosis; 1996;125:1–13. doi:10.1016/0021-9150(96)05821-3
Hauner H, Stangl K, Burger K, et al. Sex hormone concentrations in men with angiographically assessed coronary artery disease: Relationship to obesity and body fat distribution. Klinische Wochenschrift; 1991;69:664–668. doi:10.1007/BF01648102
Van Pottelbergh I, Braeckman D, De Bacquer D, et al. Differential contribution of testosterone and estradiol in the determination of cholesterol and lipoprotein profile in healthy middle-aged men. Atherosclerosis; 2003;166:95–102. doi:10.1016/S0021-9150(02)00317-4
Tchernof A, Labrie F, Belanger A, et al. Relationships between endogenous steroid hormone, sex hormone-binding globulin and lipoprotein levels in men: Contribution of visceral obesity, insulin levels and other metabolic variables. Atherosclerosis; 1997;133:235–244. doi:10.1016/S0021-9150(97)00182-7
Haffner SM, Mykkanen L, Valdez RA, et al. Relationship of sex hormones to lipids and lipoproteins in nondiabetic men. Journal of Clinical Endocrinology & Metabolism; 1993;77:1610–1615. doi:10.1210/jcem.77.6.8263141
Sewdarsen M, Vythilingum S, Jialal I, et al. Abnormalities in sex hormones are a risk factor for premature manifestation of coronary artery disease in South African Indian men. Atherosclerosis; 1990;83:111–117. doi:10.1016/0021-9150(90)90090-2
Aksut SV, Aksut G, Karamehmetoglu A, et al. The determination of serum estradiol, testosterone and progesterone in acute myocardial infarction. Japanese Heart Journal; 1986;27:825–837. doi:10.1536/ihj.27.825
Khaw KT, Dowsett M, Folkerd E, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation;2007;116:2694–2701. doi:10.1161/CIRCULATIONAHA.107.719005
Malkin CJ, Pugh PJ, Morris PD, et al. Low serum testosterone and increased mortality in men with coronary heart disease. Heart;2010;96(22):1821-1825. doi:10.1136/hrt.2010.201970
Wehr E, Pilz S, Boehm BO, et al. Sex steroids and mortality in men referred for coronary angiography. Clinical Endocrinology; 2010;73(5):613-621. doi:10.1111/j.1365-2265.2010.03845.x
Hu X, Rui L, Zhu T, et al. Low testosterone level in middle-aged male patients with coronary artery disease. European Journal of Internal Medicine; 2011;22(6). doi:10.1016/j.ejim.2011.06.003
Sieveking DP, Lim P, Chow RW, Dunn LL, et al. A sex-specific role for androgens in angiogenesis. Journal of Experimental Medicine; 2010;207(2):345-352. doi:10.1084/jem.20091924
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Pages
103-120
Published
October 8, 2024
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