Do DHEA/DHEAS play a protective role in coronary heart disease?

Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEAS), the major androgens secreted by human adrenal glands, were suggested to play a protective role in the pathogenesis of atherosclerosis and coronary heart disease. On the basis of a critical review of all existing studies we concluded that 1) there is no evidence of a protective role of DHEA and DHEAS in women, and 2) men with low plasma DHEA and DHEAS levels can be considered as beings at risk of developing a fatal cardiovascular event. These androgens can interfere with atherogenic process by several mechanisms. They influence enzymes such as glucoso-6-phosphate dehydrogenase, which can modify the lipid spectrum. Furthermore, they can inhibit human platelet aggregation, enhance fibrinolysis, slow down cell proliferation and reduce plasma levels of plasminogen activator inhibitor type 1 and tissue plasminogen activator antigen. We suggest that all these DHEA(S) actions are dependent on sex hormone metabolic pathways. There are still insufficient data to advise DHEA supplementation in elderly men, but this type of hormone replacement therapy merits further studies.