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Mirzohreh ST, Panahi P, Zafardoust H, Zavvar M, Fathi N, Dehghan M, Sarbakhsh P. The role of polycystic ovary syndrome in preclinical left ventricular diastolic dysfunction: an echocardiographic approach: a systematic review and meta-analysis. Cardiovasc Endocrinol Metab 2023; 12:e0294. [PMID: 37900050 PMCID: PMC10611352 DOI: 10.1097/xce.0000000000000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of childbearing age, causing hormonal imbalances, reproductive issues, and metabolic disturbances. Women with PCOS have an increased risk of cardiovascular disease due to insulin resistance, obesity, and hyperandrogenism. Detecting impaired left ventricular (LV) function is important in managing this condition. Echocardiography, a non-invasive imaging technique, can effectively detect LV dysfunction. Aim The goal of this systematic review was to assess whether there are any variations in echocardiographic measures between women with PCOS and those without the condition in order to determine the potential impact of PCOS on LV function. Methods This review followed the PRISMA reporting guidelines. A thorough search of databases including PubMed, Scopus, Web of Science, and Cochrane was conducted. The quality of the selected studies was assessed using the Joanna Briggs Institute appraisal instruments. After applying strict eligibility criteria, data were extracted and organized in Microsoft Excel sheets. Review Manager (RevMan) software was used for the analysis. Results Analysis of 29 studies revealed significant differences in echocardiographic measures related to diastolic function between women with PCOS and healthy controls. However, there were no significant differences in measures of systolic function. Conclusion These findings indicate that PCOS may be linked to impaired LV function, thereby increasing the risk of cardiovascular disease. Further research is necessary to better understand this association and its clinical implications. Early detection and management of PCOS could potentially help prevent cardiovascular complications in affected women.
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Affiliation(s)
- Seyedeh-Tarlan Mirzohreh
- Student Research Committee, Tabriz University of Medical Sciences
- Cardiovascular Research Center, Shahid Madani Heart Center, Tabriz University of Medical Sciences
| | - Padideh Panahi
- Student Research Committee, Tabriz University of Medical Sciences
| | | | - Morteza Zavvar
- Student Research Committee, Tabriz University of Medical Sciences
| | - Nima Fathi
- Student Research Committee, Tabriz University of Medical Sciences
| | - Mahshid Dehghan
- Student Research Committee, Tabriz University of Medical Sciences
| | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Kałużna M, Krauze T, Ziemnicka K, Wachowiak-Ochmańska K, Kaczmarek J, Janicki A, Wykrętowicz A, Ruchała M, Guzik P. Cardiovascular, anthropometric, metabolic and hormonal profiling of normotensive women with polycystic ovary syndrome with and without biochemical hyperandrogenism. Endocrine 2021; 72:882-892. [PMID: 33619670 PMCID: PMC8159804 DOI: 10.1007/s12020-021-02648-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/22/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE Women with polycystic ovary syndrome (PCOS) present with or without biochemical hyperandrogenism (HAPCOS or non-HAPCOS, respectively). Cardiometabolic and hormonal abnormalities have been reported in women with PCOS, particularly those with hypertension. However, no direct comparison between normotensive (blood pressure <140/90 mmHg) patients with HAPCOS and non-HAPCOS has been made. This study compared different cardiovascular (CV), anthropometric, metabolic and hormonal features between normotensive patients with HAPCOS and non-HAPCOS and healthy women. METHODS We consecutively recruited 249 normotensive patients with PCOS and 85 healthy eumenorrheic women to a case-control observational study. Based on blood androgen concentration, patients with PCOS were divided into HAPCOS (n = 69) or non-HAPCOS (n = 180) groups. RESULTS Although within normal ranges, patients with HAPCOS had significantly (p < 0.05) higher peripheral and central systolic blood pressure and pulse pressure, C-reactive protein, low-density lipoprotein cholesterol, triglycerides, glucose, and insulin than subjects with non-HAPCOS, and healthy women. They also had lower N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration. In contrast, their body mass index (BMI) was higher of over 4 kg/m2 than patients with non-HAPCOS and nearly 6 kg/m2 than in healthy participants. Except for BMI, statistical differences in the cardiometabolic profile were of little clinical relevance. CONCLUSIONS Young normotensive women with HAPCOS have a worse cardiometabolic profile but lower NT-proBNP concentration than patients with non-HAPCOS. Features of this profile in both PCOS groups are within ranges typical for healthy women. Increased BMI is the only clinically relevant feature differentiating hyperandrogenic from non-hyperandrogenic patients with PCOS, and healthy women.
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Affiliation(s)
- Małgorzata Kałużna
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
- Endocrinology, Metabolism and Internal Diseases Ward, Heliodor Swiecicki University Hospital, Poznan, Poland
| | - Tomasz Krauze
- Department of Cardiology - Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Ziemnicka
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
- Endocrinology, Metabolism and Internal Diseases Ward, Heliodor Swiecicki University Hospital, Poznan, Poland
| | | | - Jolanta Kaczmarek
- Central Laboratory, Heliodor Swiecicki University Hospital, Poznan, Poland
| | - Adam Janicki
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Wykrętowicz
- Department of Cardiology - Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
- Endocrinology, Metabolism and Internal Diseases Ward, Heliodor Swiecicki University Hospital, Poznan, Poland
| | - Przemysław Guzik
- Department of Cardiology - Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland.
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Bachmann KN, Huang S, Lee H, Dichtel LE, Gupta DK, Burnett JC, Miller KK, Wang TJ, Finkelstein JS. Effect of Testosterone on Natriuretic Peptide Levels. J Am Coll Cardiol 2020; 73:1288-1296. [PMID: 30898204 DOI: 10.1016/j.jacc.2018.12.062] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/15/2018] [Accepted: 12/10/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Circulating natriuretic peptide (NP) levels are markedly lower in healthy men than women. A relative NP deficiency in men could contribute to their higher risk of hypertension and cardiovascular disease. Epidemiological studies suggest testosterone may contribute to sex-specific NP differences. OBJECTIVES This study aimed to determine the effect of testosterone administration on NP levels using a randomized, placebo-controlled design. METHODS One hundred and fifty-one healthy men (20 to 50 years of age) received goserelin acetate to suppress endogenous production of gonadal steroids, and anastrazole to suppress conversion of testosterone to estradiol. Subjects were randomized to placebo gel or 4 different doses of testosterone (1%) gel for 12 weeks. Serum N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and total testosterone levels were measured at baseline and follow-up. RESULTS Men who did not receive testosterone replacement (placebo gel group) after suppression of endogenous gonadal steroid production experienced a profound decrease in serum testosterone (median 540 to 36 ng/dl; p < 0.0001). This was accompanied by an increase in median NT-proBNP (+8 pg/ml; p = 0.02). Each 1-g increase in testosterone dose was associated with a 4.3% lower NT-proBNP at follow-up (95% confidence interval: -7.9% to -0.45%; p = 0.029). An individual whose serum testosterone decreased by 500 ng/dl had a 26% higher predicted follow-up NT-proBNP than someone whose serum testosterone remained constant. CONCLUSIONS Suppression of testosterone production in men led to increases in circulating NT-proBNP, which were attenuated by testosterone replacement. Inhibition of NP production by testosterone may partly explain the lower NP levels in men. (Dose-Response of Gonadal Steroids and Bone Turnover in Men; NCT00114114).
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Affiliation(s)
- Katherine N Bachmann
- Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - Shi Huang
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Laura E Dichtel
- Neuroendocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Deepak K Gupta
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John C Burnett
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Thomas J Wang
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joel S Finkelstein
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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Karadağ C, Yoldemir T. Relation of NT-probnp levels and cardiovascular disease risk factors in lean women with polycystic ovary syndrome. J OBSTET GYNAECOL 2019; 39:1154-1159. [PMID: 31215274 DOI: 10.1080/01443615.2019.1603213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Women with polycystic ovary syndrome (PCOS) often have cardiovascular disease (CVD) risk factors. N-terminal fragment of brain natriuretic peptide (Nt-probnp) is used as a diagnostic and prognostic marker for CVD. The aim of this study was to evaluate whether Nt-probnp is increased in lean PCOS patients. A total of 110 lean (BMI < 25 kg/m2) PCOS patients and 80 age and BMI matched healthy lean controls were included in this study. Serum Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), Matsuda insulin sensitivity index (ISI), Nt-probnp, C-reactive protein (CRP), androgen and lipid levels were measured. Serum Nt-probnp levels were significantly higher in the PCOS group. Hyperandrogenic PCOS patients had higher Nt-probnp levels. There were significant correlations between serum Nt-probnp and total testosterone, total cholesterol, HOMA and Matsuda levels. Linear regression analysis showed that Matsuda ISI and fasting insulin levels significantly affected the Nt-probnp levels (R2 of the model = 0.763; p<.0001). IMPACT STATEMENT What is already known on this subject? Many risk factors for cardiovascular disease (CVD) including insulin resistance, dyslipidaemia, hypertension and hyperandrogenism may be found in young women with polycystic ovary syndrome (PCOS), although evidence for CVD in lean women with PCOS is limited. N-terminal fragment of brain natriuretic peptide (NT-probnp) is a high predictive marker regarding of CVD, especially in patients without overt CVD. There have been contradictory results regarding Nt-probnp levels in PCOS patients and there have not been any effective studies regarding the relation between CVD risk factors and Nt-probnp levels for lean PCOS patients. What the results of this study add? This study found increased Nt-probnp levels in lean PCOS patients, which may indicate a positive correlation with risk for CVD. Strong relations were also found between Nt-probnp levels and increased insulin resistance, dyslipidaemia, decreased insulin sensitivity and hyperandrogenism. Lean PCOS patients have increased risk factors for CVD, and these risk factors are correlated with Nt-probnp levels. Nt-probnp is more affected by increased fasting insulin and decreased insulin sensitivity. What the implications are of these findings for clinical practice and/or further research? Lean PCOS patients should be evaluated for CVD. Further prospective controlled studies are needed in order to predict the long-term risk of developing CVD in lean PCOS patients.
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Affiliation(s)
- Cihan Karadağ
- Department of Obstetrics and Gynecology, Okan University School of Medicine , İstanbul , Turkey
| | - Tevfik Yoldemir
- Department of Obstetrics and Gynecology, Marmara University School of Medicine , İstanbul , Turkey
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Ersahin AA, Acet M, Ersahin SS, Acet T, Yardim M, Kenanoglu O, Aydin S. Follicular fluid cerebellin and betatrophin regulate the metabolic functions of growing follicles in polycystic ovary syndrome. Clin Exp Reprod Med 2017; 44:33-39. [PMID: 28428942 PMCID: PMC5395550 DOI: 10.5653/cerm.2017.44.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/09/2017] [Accepted: 02/02/2017] [Indexed: 11/12/2022] Open
Abstract
Objective The aim of this study was to assess the changes of follicular fluid (FF) and serum levels of cerebellin precursor protein 1 (cbln1) and betatrophin in patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with a gonadotropin-releasing hormone (GnRH) antagonist protocol. Methods Twenty infertile women with PCOS and 20 control women diagnosed as poor responders undergoing ovarian stimulation with a GnRH antagonist were included. Blood samples were obtained during ovum pick-up. Follicular fluid from a dominant follicle was collected from the subjects. Using enzyme-linked immunosorbent assays, FF and serum levels of cbln1 and betatrophin were measured in both groups of participants. Metabolic and hormonal parameters were also determined and correlated with each other. Results Both groups of women had similar serum and FF betatrophin levels (55.0±8.9 ng/mL vs. 53.1±10.3 ng/mL, p=0.11). The serum and FF betatrophin levels of poor responders were found to be similar (49.9±5.9 ng/mL vs. 48.9±10.7 ng/mL, p=0.22). Conversely, the FF cbln1 levels of PCOS women were found to be significantly higher than the serum cbln1 levels (589.1±147.6 ng/L vs. 531.7±74.3 ng/L, p<0.02). The FF cbln1 levels of control participants without PCOS were significantly higher than their serum cbln1 levels (599.3±211.5 ng/L vs. 525.3±87.0 ng/L, p=0.01). Positive correlations were detected among body mass index, insulin resistance, serum insulin, total testosterone, and betatrophin levels in the PCOS group. Conclusion Follicular fluid betatrophin and cbln1 concentrations may play a pivotal role on follicular growth in PCOS subjects undergoing IVF/ICSI with an antagonist protocol.
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Affiliation(s)
- Aynur Adeviye Ersahin
- Department of Obstetrics and Gynecology, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Mustafa Acet
- Department of Obstetrics and Gynecology, Medipol University School of Medicine, Istanbul, Turkey
| | - Suat Suphan Ersahin
- Department of Obstetrics and Gynecology, Kemerburgaz University School of Medicine, Istanbul, Turkey
| | - Tuba Acet
- Department of Obstetrics and Gynecology, Medicine Hospital, Istanbul, Turkey
| | - Meltem Yardim
- Department of Medical Biochemistry (Firat Hormones Research Group), Firat University School of Medicine, Elazig, Turkey
| | - Omer Kenanoglu
- Department of Medical Biochemistry (Firat Hormones Research Group), Firat University School of Medicine, Elazig, Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry (Firat Hormones Research Group), Firat University School of Medicine, Elazig, Turkey
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Gateva A, Kamenov Z, Tsakova A. NT-proBNP levels in premenopausal women with polycystic ovarian syndrome and/or obesity. J OBSTET GYNAECOL 2014; 33:868-72. [PMID: 24219732 DOI: 10.3109/01443615.2013.813912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
According to some studies, polycystic ovarian syndrome (PCOS) patients have an increased risk for diabetes mellitus and often show an adverse cardiovascular risk profile. NT-proBNP was shown to have a high predictive value regarding cardiovascular events, especially in those without overt cardiovascular disease. The aim of this study was to investigate the levels of NT-proBNP in 70 women with PCOS and/or obesity in relation to other classical cardiovascular risk factors. There was no statistical difference between NT-proBNP levels between obese, lean PCOS and obese PCOS patients; between patients with or without metabolic syndrome; or between patients with different cardiovascular risk, according to The Androgen Excess and PCOS Society consensus. NT-proBNP does not show significant correlation to age, weight, BMI, WHR, WSR, systolic or diastolic blood pressure and results from oral glucose tolerance test (OGTT), except for immunoreactive insulin (IRI) at 120 min. NT-proBNP correlates weakly with HDL, but not with other indices of lipid metabolism.
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Yilmaz E, Celik O, Celik N, Simsek Y, Celik E, Yildirim E. Serum orexin-A (OXA) level decreases in polycystic ovarian syndrome. Gynecol Endocrinol 2013; 29:388-90. [PMID: 23350701 DOI: 10.3109/09513590.2012.754874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM In the current study, we aimed to investigate whether serum orexin-A (OXA) levels are different in polycystic ovary syndrome (PCOS) subjects. MATERIALS AND METHODS Thirty-six women with PCOS and 40 healthy, age and body mass index-matched controls were included in the prospective cross-sectional study. All subjects underwent venous blood draws during the early follicular phase after overnight fasting. Serum OXA levels were measured with an enzyme immunoassay (EIA). The relationships between the serum OXA levels and the anthropometric and metabolic parameters were also assessed. RESULTS The serum OXA levels were lower in the women with PCOS compared to the control group. The serum OXA levels were correlated negatively with systolic blood pressure, the Ferriman-Gallway score and LH and free testosterone levels. CONCLUSION Our results indicate that serum OXA levels decrease in the serum of women with PCOS.
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Affiliation(s)
- Ercan Yilmaz
- Obstetrics and Gynecology Department, Faculty of Medicine, Turgut Ozal Medical Centre, Inonu University, Malatya, Turkey.
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Celik Ö, Yılmaz E, Celik N, Minareci Y, Turkcuoglu I, Simsek Y, Celik E, Karaer A, Aydin S. Salusins, newly identified regulators of hemodynamics and mitogenesis, increase in polycystic ovarian syndrome. Gynecol Endocrinol 2013; 29:83-6. [PMID: 22827297 DOI: 10.3109/09513590.2012.706667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the current study, we aimed to investigate whether serum salusin α and β levels are different in PCOS subjects. Fifty women with PCOS and 50 healthy, age- and body mass index matched controls were included to the prospective cross-sectional study. All subjects underwent venous blood drawing on the early follicular phase after an overnight fasting. Serum salusin α and β levels were measured with EIA, and ELISA respectively. The relationships between serum salusin levels and anthropometric and metabolic parameters were also assessed. Plasma salusin α and β levels were higher in women with PCOS compared to control group. Serum salusin α level correlated positively with salusin β and fasting serum insulin levels. The serum salusin β levels were correlated positively with HOMA-IR, TG, LDL-C, LH, FSH, and total testosterone levels. Our results indicate that salusins, newly identified regulators of hemodynamics and mitogenesis, are increased within the serum of women with PCOS.
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Affiliation(s)
- Önder Celik
- Department of Obstetrics and Gynecology, Inonu University, Medical Faculty, Malatya, Turkey.
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Deveer R, Engin-Üstün Y, Uysal S, Su FA, Sarıaslan S, Gülerman C, Mollamahmutoğlu L. Serum brain natriuretic peptide and C-reactive protein levels in adolescent with polycystic ovary syndrome. Gynecol Endocrinol 2012; 28:602-5. [PMID: 22316276 DOI: 10.3109/09513590.2011.650758] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Our primary aim was to investigate whether N-terminal pro-brain natriuretic peptide (NT-proBNP) increases in adolescent with polycystic ovary syndrome (PCOS) compared with healthy controls and secondary aim was to determine whether metabolic and hormonal differences exist between groups. METHODS In this cross-sectional study, 25 adolescent patients with PCOS and 25 normal ovulatory control not suffering from PCOS were involved in the study. Fasting serum NT-proBNP, C-reactive protein (CRP), homocystein, insulin levels and biochemical and hormonal parameters were measured. RESULTS Serum NT-proBNP was not significantly different in PCOS subjects (0.62 ± 0.80 vs 1.12 ± 1.51 ng/mL, p = 0.154). The mean serum fasting insulin levels (22.64 ± 10.51 vs 13.32 ± 3.97 mIU/mL, p = 0.001) and Homeostasis Model Assessment Insulin-Resistance Index (HOMA-IR) levels (5.16 ± 1.81 vs 2.97 ± 0.89, p = 0.001) were significantly high in the study group. The median serum CRP levels were not significantly different between groups (1 [1-12] vs 1 [1-19] g/dL, p = 0.286). CONCLUSIONS The present study demonstrated that the levels of BNP, CRP and homocystein were not different in PCOS subjects. Serum insulin levels and HOMA-IR were significantly higher in PCOS subjects. Possible serum markers for PCOS-related metabolic abnormalities and cardiovascular events, may not present in the adolescent years.
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Affiliation(s)
- Rüya Deveer
- Gynecology and Obstetrics Department, Dr. Zekai Tahir Burak Women Health Education and Research Hospital, Ankara, Turkey.
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Sirmans SM, Weidman-Evans E, Everton V, Thompson D. Polycystic Ovary Syndrome and Chronic Inflammation: Pharmacotherapeutic Implications. Ann Pharmacother 2012; 46:403-18. [DOI: 10.1345/aph.1q514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective: To examine the relationship between polycystic ovary syndrome (PCOS), cardiovascular risk factors, cardiovascular disease (CVD), and chronic inflammation and analyze data regarding pharmacologic therapies that are recommended to reduce CVD risk in PCOS and the impact of those therapies on chronic inflammation. Data Sources: A search of MEDLINE (1950-October 2011) was conducted to identify clinical studies pertaining to the identification and treatment of CVD and chronic low-grade inflammation in PCOS, Search terms included polycystic ovary syndrome, cardiovascular disease, inflammation, metformin, thiazolidinedione, and statin. Bibliographies of these studies and review articles were also examined. Study Selection and Data Extraction: English-language clinical studies evaluating the effect of metformin, thiazolidinediones, and statins on inflammatory markers, endothelial function, adhesion molecules, fibrinolysis, cytokines, and adipokines in PCOS were included. Data Synthesis: Women with PCOS have an increased prevalence of many cardiovascular risk factors including obesity, android fat distribution, insulin resistance, impaired glucose tolerance, diabetes, dyslipidemia, hypertension, and metabolic syndrome. Markers of chronic low-grade inflammation, which are associated with an increased risk of CVD, are also elevated in PCOS. Clinical guidelines recommend the use of insulin sensitizers and statins to prevent CVD in some patients with PCOS. Current literature indicates that each of these medication classes has beneficial effects on inflammation, as well. Although there are currently no studies to determine whether these treatments decrease CVD in PCOS, it can be hypothesized that drugs impacting chronic inflammation may reduce cardiovascular risk. Some studies show that metformin, thiazolidinediones, and statins have beneficial effects on inflammatory markers in PCOS; however, the data are inconsistent. Conclusions: There is insufficient information to recommend any pharmacologic therapies for their antiinflammatory effects in PCOS in the absence of other indications such as diabetes and dyslipidemia.
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Affiliation(s)
- Susan Maureen Sirmans
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe
| | - Emily Weidman-Evans
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe; Clinical Assistant Professor (gratis), Department of Family Medicine and Comprehensive Care, Louisiana State University Health Sciences Center-Shreveport
| | - Victoria Everton
- Department of Family Medicine and Comprehensive Care, Louisiana State University Health Sciences Center-Shreveport
| | - Daniel Thompson
- Department of Family Medicine and Comprehensive Care, Louisiana State University Health Sciences Center-Shreveport
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Celik O, Celik N, Hascalik S, Sahin I, Aydin S, Ozerol E. An appraisal of serum preptin levels in PCOS. Fertil Steril 2011; 95:314-6. [PMID: 20883990 DOI: 10.1016/j.fertnstert.2010.08.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 08/17/2010] [Accepted: 08/25/2010] [Indexed: 12/31/2022]
Abstract
Plasma preptin levels were higher in women with PCOS compared with the control group (mean±SD, 823.2±140.7 vs. 324.9±147.3 pg/mL). This article suggests a potential role of preptin in the pathogenesis of PCOS.
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Affiliation(s)
- Onder Celik
- Department of Obstetrics, Inonu University, Medical Faculty, and Beydagi State Hospital Biochemistry, Malatya, Turkey.
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Celik O, Yesilada E, Hascalik S, Celik N, Sahin I, Keskin L, Ozerol E. Angiotensin-converting enzyme gene polymorphism and risk of insulin resistance in PCOS. Reprod Biomed Online 2009; 20:492-8. [PMID: 20138007 DOI: 10.1016/j.rbmo.2009.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 08/26/2009] [Accepted: 11/30/2009] [Indexed: 11/15/2022]
Abstract
The aim of this study was to establish the frequency of angiotensin-converting enzyme (ACE) insertion (I) or deletion (D) gene polymorphism in women with polycystic ovary syndrome (PCOS) and to examine the association of this polymorphism with insulin resistance. A total of 32 women with PCOS and 31 healthy, age- and body mass index-matched controls were studied. Serum lipids, fasting glucose, insulin and other hormones concentrations were measured. Homeostasis model assessment was used to estimate insulin resistance (HOMA-IR). DNA was extracted from peripheral blood leukocytes and genotyping of ACE I/D polymorphism was carried out by polymerase chain reaction. ACE genotypes were distributed as follows: DD was present in 16 (50%), ID in 12 (37.5%) and II in four (12.5%) PCOS patients, and DD in seven (22.6%), ID in 20 (64.5%) and II in four (12.9%) of healthy subjects. The frequency of D and I alleles were found in 69% and 31% of the PCOS group and 55% and 45% in the control group, respectively. There were no significant differences regarding the genotypic distribution and allelic frequency between the groups. However the ACE DD genotype was significantly associated with serum insulin concentrations and HOMA-IR measurement (both P=0.005). ACE DD genotype is associated with an increased insulin resistance in women with PCOS.
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Affiliation(s)
- Onder Celik
- Departments of Obstetrics and Gynecology, Medical Faculty, Turgut Ozal Medical Center, Inonu University, Malatya, Turkey
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Tassone F, Gianotti L, Rolfo F, Visconti G, Borretta G, Feola M. B-type natriuretic peptide levels and insulin resistance in patients with severe ischemic myocardial dysfunction. J Endocrinol Invest 2009; 32:805-9. [PMID: 19468263 DOI: 10.1007/bf03345749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
B-type natriuretic peptide (BNP) is an important clinical parameter of severity in congestive heart failure (CHF). Recent findings suggest a close relation between lipid and glucose metabolism and the natriuretic peptide axis, even if conflicting data exist on the relationship between natriuretic peptide levels and insulin resistance (IR). Thus, we sought to investigate potential relations between BNP level and IR in 134 patients with severe ischemic myocardial dysfunction [mean+/-SD: age =64.8+/-9.6 yr, male/female =104/30; body mass index (BMI) =25.5+/-4.05 kg/m2, 26.1% diabetics; ejection fraction (EF) = 30.2+/-7.7%]. In univariate analysis, an inverse relationship between BNP levels and EF% was observed (R=-0.43, p=0.0006). Moreover, we found an inverse association between BNP levels and BMI (R=-0.27, p=0.036), and also between BNP and homeostasis model assessment of insulin resistance (HOMA-IR) (R=-0.27, p=0.039). In multivariate analysis, EF% and HOMA-IR were significantly and independently associated with logarithmically transformed BNP levels (beta=-0.40, p=0.019 and beta=-0.26, p=0.042, respectively; R2=0.36). In conclusion, in patients with severe ischemic myocardial dysfunction EF and IR are independently associated with BNP levels explaining about 1/3 of the variability of this parameter. Multiple potential mechanisms may underlie this association, but it seems now clinically important to take into account also metabolic features when interpreting plasma natriuretic peptide concentrations obtained for diagnostic or prognostic purposes.
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Affiliation(s)
- F Tassone
- Division of Endocrinology and Metabolism, S. Croce e Carle Hospital, Via Michele Coppino 26, 120100 Cuneo, Italy.
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Clinical applications of N-terminal pro B-type natriuretic peptide in heart failure and other cardiovascular diseases. Heart Fail Rev 2009; 15:293-304. [DOI: 10.1007/s10741-009-9142-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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