DHEA May Protect Against Atherosclerosis

DHEA and Policosanol for Heart Health

DHEA May Protect Against Atherosclerosis
Ultrasound studies of carotid arteries show
benefits in men and, perhaps, in some women
By Dr. Hyla Cass

hen it comes to sex, women have it easy. For one thing, it’s easy to do (if the motive is there), requiring little effort (for openers, at least). For another, it’s easy to get, requiring no effort at all (invitation required, of course). And a woman’s capacity for sex is virtually limitless, even into old age. Men, of course, find all this to be terribly unfair—and it is! As if having to do most of the work weren’t enough, there can be performance anxiety and, worst of all, the specter of eventual impotence (although Viagra® and similar drugs have been a boon in that department, as has the natural supplement arginine).

To add insult to injury, a French study in 2000 showed that elderly women, but not elderly men, enjoyed the sexual benefits of a treatment aimed at restoring youthful levels of DHEA (dehydroepiandrosterone), a steroid hormone that plays an important, yet still somewhat mysterious, role in the physiology of both men and women.1 DHEA levels reach their peak in our twenties and then decline steadily, in both men and women, so that by the time we reach our seventies, they’re down to about 20% of those youthful levels. Studies have shown that this decline is due primarily, if not exclusively, to a decrease in DHEA output from our adrenal glands, not to a change in our metabolism.*

*At all ages, about 90% of the DHEA in our bloodstream actually exists in the form of DHEA sulfate (DHEAS), a simple derivative produced when DHEA is metabolized by the liver. The distinction between these two forms of the hormone is usually not important.

Sexual Chemistry Can Be Pretty Confusing

Now get ready for a paradox: DHEA, the sexual benefactor of elderly women, is a male sex hormone, or androgen. Its androgenic activity is weak, but it’s a precursor (one of several) to another androgen, androstenedione, which is a precursor (one of several) to testosterone, the powerful androgen that pretty much defines masculinity. And testosterone has a definite prosexual effect in women. The paradox doesn’t stop there, though. Androstenedione is also the direct precursor to the female sex hormones estrone, estradiol, and estriol, which, together with some less important sex hormones, are collectively called estrogen.

Are you confused? The sex hormones have a way of doing that to us, in more ways than one. Men and women are not just different in profoundly important ways, but, in various aspects of physiological function, they also respond differently to some hormones, such as DHEA. The study mentioned above found that daily administration of 50 mg of DHEA increased sexual desire, sexual activity, and sexual satisfaction in older women (especially those over 70 years of age), but not, by and large, in their male counterparts. DHEA also improved the health of the women’s skin and bones. (For more on this study, see “DHEA Improves Sex and Helps Keep Women in Love” in Life Enhancement, June 2000.)

Oh, the Injustice of It! But Wait …

These results provide yet another reason for men to feel like the victims of a cruel injustice. But wait—in a different arena of human health, the tables are turned, and men can “get even” to a degree. Some studies have shown that DHEA tends to inhibit the development and progression of atherosclerosis in men (and in rabbits), but not, by and large, in women. Other studies have suggested that decreased DHEA levels may contribute to insulin resistance (the precursor condition for type 2 diabetes) in men—and men with diabetes are known to have significantly lower DHEA levels than nondiabetic men. DHEA supplementation appears to improve insulin sensitivity and to slow the progression of diabetes in men.

What About Atherosclerosis in Diabetic Men?

The studies in question were cited by the Japanese authors of a new study designed to investigate the relationship between the serum levels of DHEA and atherosclerosis in men with type 2 diabetes.2 Using the noninvasive technique of high-resolution ultrasonography, the researchers measured the wall thickness of the carotid artery in the necks of 206 diabetic men, aged 36 to 94. The carotid arteries (there are two, one on each side) lend themselves well to this technique because they’re close to the surface.

They’re also extremely important arteries, because they’re the principal source of blood for the brain. Atherosclerotic plaque in the carotid arteries is therefore highly undesirable, because impaired cerebral blood flow can have dire consequences, such as cognitive impairment that can lead to vascular dementia (the third most common type of dementia, after Alzheimer’s disease and dementia with Lewy bodies). (For more on the harm that can come to our brains from atherosclerosis, see the article on page 26 of this issue.)

DHEA May Help Protect Men from Atherosclerosis

In the Japanese study, the researchers found, as expected, that DHEA levels were negatively correlated with the men’s age, i.e., the older the men, the lower their DHEA levels. They also found significant negative correlations between DHEA levels and carotid-artery wall thickness and between DHEA levels and the total carotid “plaque score,” which could be calculated from the measurements of wall thickness. In other words, lower levels of DHEA were significantly correlated with higher values of these reliable indicators of atherosclerosis. Finally, it was observed that DHEA levels were significantly lower in the diabetic men who had cardiovascular disease (CVD) than in those who did not.

The researchers speculated that the increased risk for CVD in diabetic men could be mediated in part by their low levels of DHEA, and they wrote,

Our study supports the notion that DHEA, which is sold in increasing amount as a food supplement, is atheroprotective in humans … [some studies] suggest that DHEA has a beneficial effect against development of atherosclerosis and/or its clinical manifestations in men.

Women Reenter the Picture

Well, there you are—it’s still all about men. Or is it? Another recent study suggests that some women may also benefit, in terms of cardiovascular health, from DHEA supplementation.3 Italian researchers studied 17 morbidly obese premenopausal women (aged 20 to 41) with normal blood pressure, no CVD, and no diabetes—yet. The “yet” is because obesity is a major risk factor for CVD, and it’s by far the greatest risk factor for type 2 diabetes, so these women were living on borrowed time, in a sense.

Not surprisingly, all the women showed evidence of hyperinsulinemia, or abnormally high levels of the hormone insulin in their blood. This indicates insulin resistance, which, as mentioned above, is the precursor condition for type 2 diabetes. If the body’s cells resist the action of insulin in facilitating the transport of glucose (blood sugar) from the bloodstream into the cells, the pancreas tries to compensate by making more insulin. This mechanism may work for awhile, but if it ultimately fails, glucose levels get out of control, and diabetes sets in. This is clearly a common occurrence, as diabetes is epidemic in our overfed, underexercised society.

Could DHEA Benefit Women’s Hearts Too?

Insulin resistance is also a risk factor for atherosclerosis, the development of which was assessed by the Italian researchers from ultrasonographic measurements of the carotid artery in the 17 morbidly obese women. They found, first of all, that these women had significantly higher insulin levels and significantly lower DHEA levels than 10 women of normal weight in the same age group, who were used as controls. These endocrine abnormalities correlated with a significant tendency toward early atherosclerosis in the obese women, and the authors suggested that such abnormalities may play a pivotal role in the development of cardiovascular disease. Although they did not suggest therapeutic DHEA supplementation for women in this context, there is the possibility that it could be helpful.

Policosanol Has Proven Benefits on Cholesterol Levels

There is no doubt regarding the therapeutic benefits of another nutritional supplement in helping to prevent cardiovascular disease: policosanol. This substance, a mixture of eight solid alcohols extracted from sugar cane, has been extensively studied by Cuban scientists—and extensively covered in this magazine—for its remarkable ability to lower total cholesterol and LDL-cholesterol (“bad cholesterol”) levels and to increase HDL-cholesterol (“good cholesterol”) levels; it also reduces the serum levels of triglycerides (fats).*

*Policosanol has no effect on blood sugar levels, and even if it did, the effect would be negligible because the recommended daily amount (usually 20 mg/day) is minuscule.

In addition, policosanol inhibits platelet aggregation (the formation of blood clots) and has a protective effect on the vascular endothelium, the layer of smooth, flat cells that line the inner walls of our blood vessels. In head-to-head trials against some of the (very expensive) statin drugs, policosanol has generally been comparable or even better in its anticholesterol effects, and it’s extremely safe to use, even in very large amounts.

Policosanol May Cause Regression of Atherosclerosis

In a pilot study published in 1995, researchers in Cuba sought to measure the long-term lipid-lowering effects of policosanol therapy on the regression of atherosclerosis in the carotid and vertebral arteries of the neck.4 The subjects were 22 male and female patients, aged 44 to 76, whose lipid levels ranged from normal to elevated. All, however, showed signs of blood-flow disturbances in their carotid or vertebral arteries, indicating the presence of atherosclerosis. Detailed analysis of blood-flow patterns in these arteries can yield information regarding structural abnormalities, such as obstructions caused by thickening of the walls or by accumulations of atherosclerotic plaque. Such measurements can be made noninvasively by the technique of Doppler ultrasonography, the basis for which is described in the sidebar.

The Versatile Doppler Effect

What do blood flow, speeding cars, smart bombs, atmospheric storms, aircraft navigation, the structure of atoms, the chemical composition of stars, and the expansion of the universe have in common? These and many other things have been studied or measured or controlled by techniques that depend in part on one of the most useful phenomena in nature: the Doppler effect.

Named for the Austrian physicist Christian Johann Doppler, who predicted it in 1842, it’s universally familiar from the sound of a train whistle as a fast-moving train goes past you at a railroad crossing. As the train approaches, the whistle’s pitch (frequency) is higher than it would be if the train were stationary, and it drops to a lower-than-stationary frequency as the train recedes.* The faster the train, the greater the difference between the two frequencies.

*The Doppler effect would be exactly the same if the whistle-blowing train were stationary and you were zooming past it in a train on a parallel track. (If you were on the same track, you would, alas, hear only the first half of the Doppler effect.)

Doppler reasoned that the sound waves radiating ahead of the whistle would be compressed and therefore raised in frequency by the forward motion of the train; by contrast, the sound waves radiating behind the whistle would be expanded and therefore lowered in frequency. His mathematical theory allowed him to predict the exact amount of frequency shift for any whistle pitch at any speed of the train, measured from any angle to the train’s direction of motion.

Doppler could not have imagined the enormous impact his discovery would have on the future of science, technology, and medicine. It turned out that his effect applies not just to sound waves, but to waves of all kinds, including light waves (he predicted this too, but did not live to see it confirmed).

The electromagnetic spectrum includes radio waves, microwaves, infrared radiation, visible light, ultraviolet rays, x-rays, and gamma rays. In all these domains, the Doppler effect can be used to great advantage in measuring the speed and direction of moving objects, from subatomic particles to galaxies, and anything in between, such as a car in a traffic cop’s radar scope, a smart bomb hurtling toward a terrorist’s stronghold, or a ship or airplane or satellite getting a navigational fix from some reference point.

When pointing to storm systems on the map, the weatherman often attributes the information to “Doppler radar.” This is a technique for measuring the size, shape, and detailed structure of rainstorms, hurricanes, microbursts, tornadoes, pollution layers, and many other meteorological phenomena. Using powerful computers and advanced mathematical techniques for analyzing the torrents of data obtained from ground-based or airborne radar installations, meteorologists can produce amazingly detailed pictures of the object in question, even if it’s something as “invisible” as a wind pattern.

If the Nobel Prize had existed in Doppler’s time, he would have been a shoo-in.

Eleven of the subjects received 5 mg of policosanol twice daily (10 mg/day) for 1 year, while the other 11 received placebo. Their lipid levels were measured bimonthly, and the progression or regression of their carotid-vertebral atherosclerosis was determined by blood-flow measurements. By the end of the study, the lipid profile in the policosanol group had improved significantly, whereas in the control group it had remained essentially unchanged.

In terms of functional atherosclerosis, the members of the policosanol group showed no progression and significant regression overall, whereas the members of the control group showed nearly the opposite: significant progression and little regression. The authors stressed the important fact that lipid-lowering therapy causes regression of existing atherosclerosis even in patients with normal lipid profiles.

They concluded,

… our results suggest that policosanol, in combination with a low-fat diet, increases the frequency of partial functional regression … in patients with mild carotid-vertebral atherosclerosis and normal lipid levels or type II hyperlipidemia.

Better Heart Health—An Attainable Goal

Whether you’re a man or a woman, chances are you could benefit in some way from the use of supplemental DHEA, even if the type of benefit depends on whether you’re a man or a woman. In either case, though, it’s almost certain that you could benefit by reducing your cholesterol levels, even if they’re currently normal. That conclusion can be drawn from some recent cholesterol research of great importance.* How fortunate we are to have a safe, effective, and affordable supplement such as policosanol with which to pursue this attainable goal.

*See “Got Cholesterol? Lower It!,” “A Sea Change in Cholesterol Thinking,” and “You Can—and Ought to—Lower Your Cholesterol” in the May, June, and October 2004 issues, respectively.


  1. Baulieu ÉÉ, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, Faucounau V, Girard L, Hervy MP, Latour F, Leaud MC, Mokrane A, Pitti-Ferrandi H, Trivalle C, de Lacharrière O, Nouveau S, Rakoto-Arison B, Souberbielle JC, Raison J, Le Bouc Y, Raynaud A, Girerd X, Forette F. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA 2000 Apr 11;97(8):4279-84.
  2. Fukui M, Kitagawa Y, Nakamura N, Kadono M, Yoshida M, Hirata C, Wada K, Hasegawa G, Yoshikawa T. Serum dehydroepiandrosterone sulfate concentration and carotid atherosclerosis in men with type 2 diabetes. Atherosclerosis 2005;181:339-44.
  3. Savastano S, Valentino R, Belfiore A, De Luca N, de Alteriis A, Orio F Jr, Palomba S, Villani AM, Falconi C, Lupoli G, Lombardi G. Early carotid atherosclerosis in normotensive severe obese premenopausal women with low DHEA(S). J Endocrinol Invest 2003;26:236-43.
  4. Batista J, Stüsser R, Penichet M, Uguet E. Doppler-ultrasound pilot study of the effects of long-term policosanol therapy on carotid-vertebral atherosclerosis. Curr Therapeut Res 1995;56:906-14.

Hyla Cass, M.D., is assistant clinical professor of psychiatry at UCLA and chair of the Dept. of Complementary and Alternative Medicine at the American University of Complementary Medicine. She has written several books on herbal supplements.

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