Sex differences in the relation between sex hormones and right ventricular function in pulmonary arterial hypertension

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Background: Although pulmonary arterial hypertension (PAH) is more prevalent in women, they have superior survival, partially explained by better right ventricular (RV) function. Sex hormones are thought to play a role. However, most studies on sex hormones in PAH have not included young PAH patients. Aim: To study levels of sex hormones in younger and older PAH patients in relation to RV function. Methods: Cross-sectional analysis of 55 PAH patients and 15 controls (age 17-82 years, similar median BMI of 24.7) that underwent magnetic resonance imaging. Plasma sex hormones levels were determined with liquid chromatography–tandem mass spectrometry. Results: Median levels of dehydroepiandrosterone-sulfate (DHEAs) were lower in PAH females 9 [6-14] vs. controls 29 [21-36] µmol/L, p<0.05, and with a trend in PAH males 18 [10-25] vs. controls 28 [21-37] µmol/L, p=0.08. Free testosterone was lower in female PAH 5.6 [2.8-3.0] vs. controls 10 [9.6-9.7] pmol/L, p<0.05. The association between DHEAs and RV function was significantly different in PAH males vs. females (R2=0.26 and R2=0.03, p<0.05), but not for left ventricular stroke volume (R2=0.22 and R2=0.007, P=0.15). Conclusion: Patients with PAH have lower DHEAs and free testosterone concentrations than controls. Sex-based differences in the relation between DHEAs and RV function may have implications for sex hormone treatment in PAH.
Original languageEnglish
JournalEuropean respiratory journal
Publication statusPublished - 28 Oct 2020

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