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Kolnikaj TS, Herman R, Janež A, Jensterle M. The Current and Emerging Role of Statins in the Treatment of PCOS: The Evidence to Date. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:244. [PMID: 38399531 PMCID: PMC10890374 DOI: 10.3390/medicina60020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Polycystic ovary syndrome (PCOS) manifests a multifactorial pathology characterized by polycystic ovaries, menstrual cycle disorders, varying degrees of hyperandrogenism, and an ad-verse metabolic risk profile. The position of hyperandrogenism in this syndrome has been extensively studied. A multitude of mechanisms place it in the position of cause but also of consequence; therefore, ongoing research efforts are focused on identifying medications that can effectively reduce levels of androgens in women with PCOS. Moreover, lipid abnormalities are common in this population, with up to 70% of patients having dyslipidemia. Statins may have potential therapeutic benefits for women with PCOS, as they have been shown to improve insulin resistance and reduce the risk of cardiovascular disease. In addition, their role in accelerated steroidogenesis by limiting one source of cholesterol, influencing enzymatic activity, and providing several other beneficial mechanisms is widely investigated. This review aimed to provide a comprehensive overview of the pathogenesis of androgen excess and dyslipidemia in PCOS, as well as the therapeutic potential of statins.
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Affiliation(s)
- Tea Shehu Kolnikaj
- Department of Endocrinology, Diabetes and Metabolic Diseases, University of Medicine Tirana, 1000 Tirana, Albania;
| | - Rok Herman
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (R.H.); (A.J.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (R.H.); (A.J.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mojca Jensterle
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (R.H.); (A.J.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Yu O, Christ JP, Schulze-Rath R, Covey J, Kelley A, Grafton J, Cronkite D, Holden E, Hilpert J, Sacher F, Micks E, Reed SD. Incidence, prevalence, and trends in polycystic ovary syndrome diagnosis: a United States population-based study from 2006 to 2019. Am J Obstet Gynecol 2023; 229:39.e1-39.e12. [PMID: 37061077 DOI: 10.1016/j.ajog.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/14/2023] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age, yet US incidence estimates do not exist, and prevalence estimates vary widely. OBJECTIVE A population-based US study estimated the incidence, prevalence, and trends of polycystic ovary syndrome by age, race and ethnicity, and diagnosing provider type. STUDY DESIGN A retrospective cohort study of patients enrolled in Kaiser Permanente Washington from 2006 to 2019 was conducted. All members identified as female, aged 16 to 40 years with at least 3 years of enrollment and at least 1 healthcare encounter during that time, were eligible for inclusion. Individuals were excluded if they had a history of oophorectomy or hysterectomy. Polycystic ovary syndrome cases were identified using the International Classification of Diseases diagnosis codes (International Classification of Diseases, Ninth Revision, 256.4 or International Classification of Diseases, Tenth Revision, E28.2). Individuals with a polycystic ovary syndrome diagnosis before study entry were excluded from incidence rate estimations. The incidence rates were adjusted by age using direct standardization to the 2010 US census data. Temporal trends in incidence were assessed using weighted linear regression (overall) and Poisson regression (by age, race and ethnicity, and provider type). Prevalent cases were defined as patients with a polycystic ovary syndrome diagnosis at any time before the end of 2019. Medical record review of 700 incident cases diagnosed in 2011-2019 was performed to validate incident cases identified by International Classification of Diseases codes using the Rotterdam criteria. RESULTS Among 177,527 eligible patients who contributed 586,470 person-years, 2491 incident polycystic ovary syndrome cases were identified. The mean age at diagnosis was 26.9 years, and the mean body mass index was 31.6 kg/m2. Overall incidence was 42.5 per 10,000 person-years; the rates were similar over time but increased in individuals aged 16 to 20 years from 31.0 to 51.9 per 10,000 person-years (P=.01) and decreased among those aged 26 to 30 years from 82.8 to 45.0 per 10,000 person-years (P=.02). A small decreasing temporal trend in incidence rates was only observed among non-Hispanic White individuals (P=.01). The incidence rates by diagnosing provider type varied little over time. Among the 58,241 patients who contributed person-time in 2019, 3036 (5.2%) had a polycystic ovary syndrome International Classification of Diseases diagnosis code; the prevalence was the highest among the Hawaiian and Pacific Islander group (7.6%) followed by Native American and Hispanic groups. Medical record review classified 60% as definite or probable incident, 14% as possible incident, and 17% as prevalent polycystic ovary syndrome. The overall positive predictive value of polycystic ovary syndrome International Classification of Diseases diagnosis code for identifying definite, probable, or possible incident polycystic ovary syndrome was 76% (95% confidence interval, 72%-79%). CONCLUSION Among a cohort of nonselected females in the United States, we observed stable rates of incident polycystic ovary syndrome diagnoses over time. The incidence of polycystic ovary syndrome was 4- to 5-fold greater than reported for the United Kingdom. The prevalence of polycystic ovary syndrome (5.2%) was almost double before the published US estimates (2.9%) based on the International Classification of Diseases codes. Race and ethnicity and provider type did not seem to have a major impact on temporal rates. Incident diagnoses increased over time in younger and decreased in older age groups, perhaps related to shifting practice patterns with greater awareness among practitioners of the impact of polycystic ovary syndrome on long-term health outcomes and improved prevention efforts. Moreover, increasing obesity rates may be a factor driving the earlier ages at diagnosis.
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Affiliation(s)
- Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Jacob P Christ
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, WA
| | | | - Jennifer Covey
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Ann Kelley
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Jane Grafton
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - David Cronkite
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Erika Holden
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Jan Hilpert
- Early Clinical Development Precision Medicine, Berlin, Germany
| | | | - Elizabeth Micks
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, WA
| | - Susan D Reed
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, WA.
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Janez A, Herman R, Poredos P, Mikhailidis DP, Blinc A, Sabovic M, Studen KB, Jezovnik MK, Schernthaner GH, Anagnostis P, Antignani PL, Jensterle M. Cardiometabolic Risk, Peripheral Arterial Disease and Cardiovascular Events in Polycystic Ovary Syndrome: Time to Implement Systematic Screening and Update the Management. Curr Vasc Pharmacol 2023; 21:424-432. [PMID: 37779406 DOI: 10.2174/0115701611269146230920073301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder in women of reproductive age. It presents with gynaecologic, metabolic, and psychologic manifestations. The dominant drivers of pathophysiology are hyperandrogenism and insulin resistance. Both conditions are related to cardiometabolic risk factors, such as obesity, hypertension, dyslipidaemia, hyperglycaemia, type 2 and gestational diabetes, nonalcoholic fatty liver disease and obstructive sleep apnoea. Women with PCOS of reproductive age consistently demonstrated an elevated risk of subclinical atherosclerosis, as indicated by different measurement methods, while findings for menopausal age groups exhibited mixed results. Translation of subclinical atherosclerosis into the increased incidence of peripheral arterial disease and major cardiovascular (CV) events is less clear. Although several expert groups have advised screening, the CV risk assessment and prevention of CV events are frequently underdiagnosed and overlooked aspects of the management of PCOS. A combination of lifestyle management and pharmacotherapy, including the promising new era of anti-obesity medicine, can lead to improvements in cardiometabolic health.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Herman
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Pavel Poredos
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dimitri P Mikhailidis
- Division of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London Medical School, University College London (UCL), UK
- Department of Clinical Biochemistry, Royal Free Hospital Campus (UCL), London, UK
| | - Ales Blinc
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miso Sabovic
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katica Bajuk Studen
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mateja Kaja Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gerit-Holger Schernthaner
- Division of Angiology, Department of Medicine 2, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Mojca Jensterle
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Chiaffarino F, Cipriani S, Dalmartello M, Ricci E, Esposito G, Fedele F, La Vecchia C, Negri E, Parazzini F. Prevalence of Polycystic Ovary Syndrome in European countries and USA: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 279:159-170. [DOI: 10.1016/j.ejogrb.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
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Agarwal M, Sinha S, Lohani P, Singh R, Dureja S. Polycystic Ovarian Syndrome in Aging Women: An Observational Study. Cureus 2022; 14:e29776. [PMID: 36187169 PMCID: PMC9523976 DOI: 10.7759/cureus.29776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Polycystic ovarian syndrome (PCOS) in aging women has not been extensively studied, although it is a very common disorder. Most of the research has been conducted on women of the reproductive age group, although PCOS is a disease occurring in all age groups. This study aims to provide an idea of the PCOS pattern prevalent in aging women presenting at a tertiary care center in Eastern India. Methods: This was a prospective, single-center, observational cohort study conducted over three years, from October 2016 to September 2019. A total of 36 patients between 35 and 65 years of age were found to have PCOS according to Rotterdam’s criteria during this period. These patients were prospectively followed up to study their demographic characteristics, symptoms, management, and outcomes. Results: A total of 80% of the women were below 40 years of age, while only 20% were above 40. In total, 70% of the women were overweight or obese. Infertility was seen in 75% of patients below 40 years of age and 28% of patients above 40. Among these, 23 (95%) conceived successfully after proper management. The main presenting complaints were infertility and menstrual irregularities. With aging, diabetes increased from 24%, in below 40, to 28%, in above 40; hypertension increased from 13% to 28%. The occurrence of impaired oral glucose tolerance test (OGTT) and impaired lipid profile increased with age: from 48% to 57% and 13% to 28%, respectively. Conclusion: PCOS in aging women causes considerable morbidity and greatly affects the quality of life, although it is less understood. Further research in this field is very much needed to understand and appropriately manage the problems in aging women, to improve their quality of life.
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Osibogun O, Ogunmoroti O, Kolade OB, Hays AG, Okunrintemi V, Minhas AS, Gulati M, Michos ED. A Systematic Review and Meta-Analysis of the Association Between Polycystic Ovary Syndrome and Coronary Artery Calcification. J Womens Health (Larchmt) 2022; 31:762-771. [PMID: 35575750 PMCID: PMC9360175 DOI: 10.1089/jwh.2021.0608] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Polycystic ovary syndrome (PCOS) is a common endocrine pathology affecting women of reproductive age characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. Coronary artery calcification (CAC) is a marker of subclinical atherosclerosis and prognostic of cardiovascular disease (CVD) risk. Some studies have shown that women with PCOS have a greater risk of CAC; however, a few others report contrary findings. The objective of this study is to examine and quantify the association between PCOS and CAC. Materials and Methods: We searched EMBASE, Google Scholar, PubMed, and Web of Science from inception to November 2021 to identify studies that provided information on PCOS and CAC. We used a random-effects model to aggregate the odds ratios (ORs) for CAC (score >0) among women with PCOS compared with controls adjusted for sociodemographic characteristics and CVD risk factors. Results: From the 36 articles reviewed, 3 prospective cohort and 4 cross-sectional studies met the inclusion criteria with a total of 2341 participants. Six studies used CAC > 0 as an outcome and were included in the pooled analysis. Using the Hartung-Knapp-Sidik-Jonkman method, the pooled adjusted ORs for the associations between PCOS and the presence of CAC were 2.48 (95% confidence interval: 2.11-2.84) with no significant heterogeneity (I2 = 0.10%, p = 0.97) for the cohort studies and 1.88 (0.71-3.06) with no significant heterogeneity (I2 = 13.95%, p = 0.87) for the cross-sectional studies. Conclusion: In pooled analyses, women with PCOS had approximately twofold greater odds of having CAC compared with women without PCOS. However, additional prospective studies will be needed to further understand the relationship between PCOS and CAC.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Olamide B. Kolade
- Department of Women's Health, Geisinger Lewistown Hospital, Lewistown, Pennsylvania, USA
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Victor Okunrintemi
- Division of Cardiovascular Disease, Houston Methodist Hospital, Houston, Texas, USA
| | - Anum S. Minhas
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona, USA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kim AS, Wild RA. A Possible Screening Marker for Cardiovascular Disease in Polycystic Ovary Syndrome. J Womens Health (Larchmt) 2022; 31:751-752. [DOI: 10.1089/jwh.2022.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ashley S. Kim
- University of Oklahoma Health Sciences Center, Division of Reproductive Endocrinology and Infertility, Oklahoma City, Oklahoma, USA
| | - Robert A. Wild
- University of Oklahoma Health Sciences Center, Division of Reproductive Endocrinology and Infertility, Oklahoma City, Oklahoma, USA
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Sun D, Wu Y, Ding M, Zhu F. Comprehensive Meta-Analysis of Functional and Structural Markers of Subclinical Atherosclerosis in Women with Polycystic Ovary Syndrome. Angiology 2022; 73:622-634. [PMID: 35258380 DOI: 10.1177/00033197211072598] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between polycystic ovary syndrome (PCOS) and subclinical atherosclerosis remains unclear. We performed a comprehensive systematic review and meta-analysis to evaluate the effect of PCOS on functional and structural markers of subclinical atherosclerosis as measured by carotid intima-media thickness (cIMT), flow-mediated vasodilation (FMD), nitroglycerin-mediated vasodilation (NMD), pulse wave velocity (PWV), and coronary artery calcium (CAC). Standard mean differences (SMDs) or odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated. Ninety-six articles involving 5550 PCOS patients and 5974 controls were included. Compared with controls, PCOS patients showed significantly thicker cIMT (SMD (95% CI) = .587 (.398, .776), P < .001), lower FMD (SMD (95% CI) = -.649 (-.946, -.353), P < .001) and NMD (SMD (95% CI) = -.502 (-.686, -.317), P < .001), as well as higher PWV (SMD (95% CI) = .382 (.019, .746), P = .039), and increased CAC incidence (OR (95% CI) = 2.204 (1.687, 2.879), P < .001). When analyzing subgroups by age and body mass index (BMI), results were still significant (P < .05) except for PWV in the BMI subgroup. There was no significant result on sensitivity analysis, and Begg' test or Egger's test. PCOS contributes to subclinical atherosclerosis, resulting in functional and structural changes in cIMT, FMD and NMD, PWV, and CAC incidence.
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Affiliation(s)
- Dandan Sun
- Department of Cardiovascular Ultrasound, 159408The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Yupeng Wu
- Department of Neurosurgery, 159408The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Mingyan Ding
- Department of Cardiovascular Ultrasound, 159408The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Fang Zhu
- Department of Cardiovascular Ultrasound, 159408The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
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Abstract
The manifestations of polycystic ovary syndrome (PCOS), a ubiquitous reproductive disorder, may vary significantly depending on the severity of a number of endocrine and metabolic changes. Although no diagnostic criteria are presently available for PCOS for perimenopausal and menopausal women, the condition can still be suspected in case of a previous diagnosis of the condition, a chronic history of irregular menstrual cycles and hyperandrogenism, and/or polycystic ovarian morphology during the reproductive period. PCOS is associated with long-term health risks, including obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome and cardiovascular risk factors during reproductive age, especially in patients possessing classic phenotypes. The aim of this review was to outline the available data about the impact of PCOS on long-term health risks after reproductive age in patients with PCOS. Previously, it was assumed that women with PCOS would be more prone to develop cardiometabolic diseases after reproductive age but current data suggest that in accordance with the healing in the phenotypic characteristics of PCOS, no deterioration appears to occur in cardiometabolic health in these patients. While there is substantial evidence for a greater prevalence of abnormal subclinical atherosclerotic markers among younger patients with PCOS, data for older women are insufficient. However, there is also support for an increased risk of endometrial cancer in PCOS patients. Extensive prospective cohort studies in which healthy controls as well as patients with defining PCOS phenotypes are observed and monitored from the early reproductive period into the late postmenopausal period should now be performed in order to clarify morbidities and mortality in aging women with PCOS.
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Affiliation(s)
- Özlem Çelik
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Acıbadem University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Faruk Köse
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Acıbadem University Faculty of Medicine, İstanbul, Turkey
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Mahboobifard F, Rahmati M, Niknam A, Rojhani E, Momenan AA, Azizi F, Ramezani Tehrani F. Impact of Polycystic Ovary Syndrome on Silent Coronary Artery Disease and Cardiovascular Events; A Long-term Population-based Cohort Study. Arch Med Res 2021; 53:312-322. [PMID: 34823887 DOI: 10.1016/j.arcmed.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND The existing data regarding the impact of Polycystic Ovary Syndrome (PCOS) on the risk of developing cardiovascular disease (CVD) are conflicting. AIM To explore the effect of PCOS status on the occurrence of silent coronary artery disease (CAD)/CVD. METHODS A total of 1591 women without CVD at baseline, aged 18-45 years, including 356 PCOS patients (defined by the Rotterdam criteria) and 1235 eumenorrheic non-hirsute women without polycystic ovarian morphology (controls), were selected from the Tehran Lipid and Glucose Study (TLGS). The median follow-up was 15.4 years, and most participants were in their late reproductive years at the end of the study. Silent CAD and CVD outcomes in PCOS and control groups were compared according to the multivariable-adjusted hazard ratios (HRs) and cumulative hazard functions. RESULTS There was no difference in CVD risk factors between the PCOS and control groups. After controlling for confounders, PCOS status did not increase the risk of silent CAD (HR: 0.96, 95% CI 0.86-1.08). Regardless of PCOS status, women with a history of silent CAD showed 2.25 times higher CVD events than those without this history (95% CI 1.63-3.10). PCOS status reduced the CVD incidence by 42%, independently of silent CAD or traditional risk factors (HR: 0.58, 95% CI 0.35-0.98). CONCLUSIONS Whereas silent CAD, regardless of PCOS, accelerated CVD, PCOS preserved it, most likely due to a combination of protective factors, including the endocrine pattern in the late reproductive period, environmental/social elements, and recruiting additional counseling and lifestyle modifications.
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Affiliation(s)
- Fatemeh Mahboobifard
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atrin Niknam
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Rojhani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Abbas Momenan
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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de Medeiros SF, de Medeiros MAS, Barbosa BB, Yamamoto AKLW, Yamamoto MMW. The connection of alpha-1 acid glycoprotein inflammatory marker with anthropometric, hormonal, and metabolic characteristic of women with polycystic ovary syndrome. J Obstet Gynaecol Res 2021; 47:3571-3582. [PMID: 34265865 DOI: 10.1111/jog.14940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/28/2022]
Abstract
AIM To investigate the connection of alpha-1 acid glycoprotein inflammatory biomarker with clinical, hormonal, and metabolic characteristics in women with polycystic ovary syndrome (PCOS) and normal cycling controls. METHODS A cross-sectional study was conducted on 235 women with PCOS and 92 normal cycling controls attended between 2008 and 2018. Alpha-1 acid glycoprotein levels were correlated with clinical, anthropometric, anthropometric-metabolic indexes, and hormones of women with PCOS and controls. Simple and multivariate stepwise linear regression, matched for age and body mass index confounding variables, was performed. RESULTS Alpha-1 acid glycoprotein levels were higher in women with PCOS (p = 0.0016). In controls, it was positively correlated with waist circumference, fat mass, body adiposity index, and lipid accumulation product, and negatively correlated with sex hormone-binding globulin (p < 0.005 for all comparisons). In PCOS, it was positively correlated with testosterone, most biomarkers of central adiposity, homeostatic model assessment of insulin-resistant, erythrocyte sedimentation rate, and negatively correlated with sex hormone-binding globulin, high-density lipoprotein cholesterol, glucose/insulin ratio, and lymphocytes (p < 0.055 for all comparisons). After multivariate regression in women with PCOS, alpha-1 acid glycoprotein retained a significant positive correlation with erythrocyte sedimentation rate and C-reactive protein. CONCLUSIONS In PCOS, alpha-1 acid glycoprotein is correlated with biomarkers of adiposity, carbohydrate metabolism, and total testosterone. This inflammatory marker is also correlated with erythrocyte sedimentation rate, neutrophils, and lymphocytes, frequent markers of an inflammation state.
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Affiliation(s)
- Sebastião Freitas de Medeiros
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, Cuiabá, Brazil.,Tropical Institute of Reproductive Medicine, Cuiabá, Brazil
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Shah D, Rasool S. Polycystic Ovary Syndrome (PCOS) Transition at Menopause. J Midlife Health 2021; 12:30-32. [PMID: 34188423 PMCID: PMC8189337 DOI: 10.4103/jmh.jmh_37_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/20/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Duru Shah
- Scientific Director, Gynaecworld, Kwality House, Kemps Corner, Mumbai, India
| | - Sabahat Rasool
- Obstetrics, Gynecology & Reproductive Medicine, Government 43 Medical College, Srinagar, Jammu & Kashmir, India
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Ahmadi M, Faramarzi M, Basirat Z, Kheirkhah F, Chehrazi M, Ashabi F. Mental and personality disorders in infertile women with polycystic ovary: a case-control study. Afr Health Sci 2020; 20:1241-1249. [PMID: 33402971 PMCID: PMC7751531 DOI: 10.4314/ahs.v20i3.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility in women. Objective The current study investigated mental and personality disorders in infertile women with and without PCOS. Methods This case-control study evaluated 400 infertile women who referred to the Infertility Center in Babol city (North of Iran). Participants were categorized into the case group (201 PCOS) and the control group (199 without PCOS). All of the participants completed the Millon Clinical Multi-axial Inventory-III (MCMI-III). Results The mean scores for clinical personality patterns were significantly higher for six personality disorders (schizoid, avoidant, antisocial, depressive, sadistic, and negativistic) and for three classes of severe personality disorder patterns (schizotypal, borderline, and paranoid) in infertile women with PCOS than in women without PCOS. The mean scores for eight clinical disorders (somatoform, manic disorder, dysthymia, alcohol-dependence, drug-dependence, post-trauma stress disorder, major depression, and delusion disorder) were also higher in infertile women with PCOS than in women without PCOS. Conclusion The scores of many mental and personality disorders are higher in infertile women with PCOS than in women without PCOS. Thus, clinicians should prioritize recognizing and treating psychological problems of infertile women with PCOS.
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Affiliation(s)
- Mostafa Ahmadi
- Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Mahbobeh Faramarzi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Zahra Basirat
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Farzan Kheirkhah
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Mohammad Chehrazi
- Department of Biostatistics &Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Fatemeh Ashabi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
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Amiri M, Ramezani Tehrani F, Behboudi-Gandevani S, Bidhendi-Yarandi R, Carmina E. Risk of hypertension in women with polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Reprod Biol Endocrinol 2020; 18:23. [PMID: 32183820 PMCID: PMC7076940 DOI: 10.1186/s12958-020-00576-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/24/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A limited number of publications have assessed the prevalence of hypertension (HTN) in polycystic ovary syndrome (PCOS) patients with inconclusive results. Since in general populations the occurrence of hypertension is related to age per se, we investigated the prevalence (P) / relative risk (RR) of HTN in pooled patients with PCOS, vs control population among reproductive age women with PCOS, compared to menopause/aging patients. METHODS PubMed, Scopus, ScienceDirect, web of science, and Google scholar were systematically searched for retrieving observational studies published from inception to April 2019 investigating the HTN in patients with PCOS. The primary outcome of interest was pooled P and RR of HTN in reproductive and menopausal/aging women with PCOS compared to control population. RESULTS The pooled prevalence of HTN in reproductive and menopausal/aging women with PCOS was higher than in the control population [(Pooled P: 0.15, 95% CI: 0.12-0.18 vs. Pooled P: 0.09, 95% CI: 0.08-0.10) and (Pooled P: 0.49, 95% CI: 0.28-0.70 vs. Pooled P: 0.40, 95% CI: 0.22-0.57), respectively]. Compared to the control population, pooled relative risk (RR) of HTN patients was increased only in reproductive age PCOS (1.70-fold, 95% CI: 1.43-2.07) but not in menopausal/aging patients who had PCOS during their reproductive years. The same results were obtained for subgroups of population-based studies. Meta-regression analysis of population-based studies showed that the RR of HTN in reproductive age PCOS patients was 1.76-fold than menopausal/aging PCOS patients (P = 0.262). CONCLUSION This meta-analysis confirms a greater risk of HTN in PCOS patients but demonstrates that this risk is increased only in reproductive age women with PCOS, indicating that after menopause, having a history of PCOS may not be as an important predisposing factor for developing HTN.
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Affiliation(s)
- Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, Iran.
| | | | - Razieh Bidhendi-Yarandi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, Iran
- School of public health, Department of Epidemiology and biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Enrico Carmina
- Endocrinology Unit, Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy
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15
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Basirat Z, Faramarzi M, Chehrazi M, Amiri M, Ghofrani F, Tajalli Z. Differences between infertile women with and without PCOS in terms of anxiety, coping styles, personality traits, and social adjustment: a case-control study. Arch Gynecol Obstet 2019; 301:619-626. [PMID: 31776708 DOI: 10.1007/s00404-019-05391-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/14/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of the study was to identify differences in the level of anxiety, stress coping ways, personality traits, and social adjustments in infertile women with polycystic ovary syndrome (PCOS) compared to those without PCOS. METHODS In a case-control study, 257 infertile of women were recruited at Fatemeh Azahra Infertility and Reproductive Health Research Center (Babol, Iran) from May 2016 to December 2017. A total of 135 women with PCOS and 122 women without PCOS completed the following questionnaires; State-Trait Anxiety Inventory (STAI), Ways of Coping Questionnaire (WCQ), NEO Five-Factor Inventory (NEO-FFI), and Bell's Adjustment Inventory. RESULTS Infertile women with PCOS had a higher mean score of trait anxiety than those without PCOS (46.19 ± 5.29 vs 44.49 ± 5.13, P = 0.004), but no difference was observed for state anxiety. The two groups did not have any significant differences in the mean scores of social adjustment and ways of coping, except for social support and problem-focused coping which were higher in the PCOS group. The PCOS personality traits of PCOS infertile women were not different regarding neuroticism, extraversion, agreeableness, conscientiousness. The only exception was that infertile PCOS women had a significantly higher mean score of openness to experience than those without PCOS (P = 0.049). CONCLUSIONS Clinicians could take advantage of the psychological differences of infertile women with PCOS and without PCOS for better management of PCOS in infertility settings; despite higher levels of anxiety they are more likely to cope with stress and are welcome to new experiences.
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Affiliation(s)
- Zahra Basirat
- Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Mahbobeh Faramarzi
- Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran.
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Mania Amiri
- Obstetrics and Gynecology, Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Faezeh Ghofrani
- Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Zahra Tajalli
- Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
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Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med 2019; 30:399-404. [PMID: 31519403 DOI: 10.1016/j.tcm.2019.08.010] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/18/2019] [Accepted: 08/29/2019] [Indexed: 12/21/2022]
Abstract
Although polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women, its etiology is not entirely understood. Clinical symptoms of PCOS include acne, amenorrhea or oligomenorrhea, hirsutism, infertility, and mood disorders, which tend to be the primary focus of clinical management. However, the impact of PCOS on future cardiovascular disease (CVD) risk should not be overlooked, and opportunities to implement CVD prevention strategies in these women should be given high priority. The pathogenesis of PCOS commonly involves insulin resistance which leads to several cardiometabolic abnormalities (e.g., dyslipidemia, hypertension, glucose intolerance, diabetes, and metabolic syndrome), thereby putting women at an increased risk for CVD. Prior studies have found that subclinical CVD markers such as coronary artery calcium scores, C-reactive protein, carotid intima-media thickness, and endothelial dysfunction are more likely to be increased in women with PCOS. While the associations between PCOS and cardiometabolic abnormalities have been well established, whether PCOS is associated with subclinical and clinical CVD, independently of these CVD risk factors, is not entirely clear. Lifestyle interventions and weight management may mitigate some of these future CVD risks and should be encouraged. This review summarizes the literature on PCOS and CVD risk factors and provides recommendations that would aid clinicians in the management of these risk factors.
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17
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Peng Q, Karvonen-Gutierrez CA, Randolph, JF, Nan B, McConnell D, Harlow SD. Age at Onset of Metabolic Syndrome Among Women With and Without Polycystic Ovary Syndrome-Like Status. J Clin Endocrinol Metab 2019; 104:1429-1439. [PMID: 30517661 PMCID: PMC6435100 DOI: 10.1210/jc.2018-01428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/28/2018] [Indexed: 01/14/2023]
Abstract
CONTEXT Women with polycystic ovary syndrome (PCOS) have a higher prevalence of metabolic syndrome (MetS), but whether they develop MetS earlier than women without PCOS is unknown. Understanding the impact of PCOS on the timing of MetS onset is important for screening and clinical care in this population. DESIGN Women with PCOS-like status (PCOSp) were identified from participants of the Michigan Bone Health and Metabolism Study based upon history of irregular menstrual cycles, high free-androgen index, and high levels of antimüllerian hormone. MetS was defined according to the Adult Treatment Panel III criteria. Age at MetS onset was compared between women with and without PCOSp using an accelerated failure time model adjusted for baseline education, lifestyle factors, and midlife body weight. RESULTS Among the 496 women in the analysis, 11.7% (n = 58) were determined to have PCOSp. Over a mean follow-up of 11 years, 20 women with PCOSp and 136 women without PCOSp developed MetS. After adjusting for smoking, education, and physical activity, women with PCOSp developed MetS at an age 14.4% (95% CI -22.7, -5.2) younger than women without PCOSp. The magnitude of the association was attenuated to 5.4% in models additionally adjusted for body mass index (95% CI -12.4, 2.1). Because a typical study participant without PCOSp developed MetS at 51.5 years old, 5.4% translates to almost 3 years earlier onset of MetS for a comparable woman with PCOSp. CONCLUSIONS Women with PCOSp develop MetS at a younger age. Earlier screening for MetS in women with PCOS may be warranted.
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Affiliation(s)
- Qing Peng
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
- Correspondenceand Reprint Requests: Qing Peng, MPH, University of Michigan School of Public Health. 1415 Washington Heights, Room 6622 SPH I, Ann Arbor, Michigan 48109-2029. E-mail:
| | | | - John F Randolph,
- 2Division of Reproductive Endocrinology and Infertility, University of Michigan Health System, Ann Arbor, Michigan
| | - Bin Nan
- 3Department of Statistics, University of California at Irvine, Irvine, California
| | - Daniel McConnell
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Siobán D Harlow
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
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Sharma A, Kapoor E, Singh RJ, Chang AY, Erickson D. Diagnostic Thresholds for Androgen-Producing Tumors or Pathologic Hyperandrogenism in Women by Use of Total Testosterone Concentrations Measured by Liquid Chromatography-Tandem Mass Spectrometry. Clin Chem 2018; 64:1636-1645. [DOI: 10.1373/clinchem.2018.290825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Previously defined thresholds for total testosterone (TT) concentrations to screen for androgen-producing tumors (APTs) have used RIA, which can be less accurate in women. We aimed to define diagnostic thresholds to screen for APTs or postmenopausal pathologic hyperandrogenism using TT concentrations measured by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS).
METHODS
We performed a retrospective cohort study on all women with TT ≥3.5 nmol/L and all postmenopausal women presenting with hyperandrogenism between 2004 and 2014 at the Mayo Clinic in Rochester, MN.
RESULTS
Of the 369 women with TT ≥3.5 nmol/L, 89 were included and subdivided into 3 groups based on their clinical diagnosis [21 (24%), APT; 16 (18%), postmenopausal pathologic hyperandrogenism; 52 (58%), polycystic ovary syndrome]. The source of the APT was more frequently ovarian (81%, n = 17) than adrenal (19%, n = 4). The diagnostic threshold using ROC analysis for TT to identify APT in women with severe biochemical hyperandrogenemia was ≥5.1 nmol/L (sensitivity, 90%; specificity, 81%). In a second analysis of a cohort of postmenopausal women only presenting with symptoms or signs of hyperandrogenism, median TT was significantly higher in the postmenopausal pathologic hyperandrogenism group (APT and ovarian hyperthecosis) vs the idiopathic hyperandrogenism group (4.9 vs 0.8 nmol/L; P < 0.01). In postmenopausal women, the diagnostic threshold for pathologic hyperandrogenism was TT ≥2.2 nmol/L (sensitivity, 100%; specificity, 86%).
CONCLUSIONS
The diagnostic threshold for TT concentration as measured by LC-MS/MS to identify APT in women with biochemical severe hyperandrogenemia was TT ≥5.1 nmol/L. In postmenopausal women, the diagnostic threshold for pathologic hyperandrogenism was lower (TT ≥2.2 nmol/L).
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Affiliation(s)
- Anu Sharma
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester MN
| | - Ekta Kapoor
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester MN
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN
| | - Alice Y Chang
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester MN
| | - Dana Erickson
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester MN
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Cooney LG, Dokras A. Beyond fertility: polycystic ovary syndrome and long-term health. Fertil Steril 2018; 110:794-809. [DOI: 10.1016/j.fertnstert.2018.08.021] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 12/30/2022]
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20
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Skiba MA, Islam RM, Bell RJ, Davis SR. Understanding variation in prevalence estimates of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2018; 24:694-709. [DOI: 10.1093/humupd/dmy022] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/24/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Marina A Skiba
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Rakibul M Islam
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Robin J Bell
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Susan R Davis
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
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Abstract
PURPOSE OF REVIEW Polycystic ovary syndrome (PCOS) is diagnosed by its characteristic reproductive features. However, PCOS is also associated with metabolic abnormalities, including insulin resistance and β-cell dysfunction. The severity of these abnormalities varies according to the reproductive phenotype, with the so-called NIH or classic phenotype conferring the greatest metabolic risk. The increased risk for type 2 diabetes (T2D) is well established among affected women with the NIH phenotype, but whether PCOS also confers an increased risk for cardiovascular events remains unknown. RECENT FINDINGS Recent studies in daughters of affected women have found evidence for pancreatic β-cell dysfunction prior to menarche. Further, genetic analyses have provided evidence that metabolic abnormalities such as obesity and insulin resistance contribute to the pathogenesis of PCOS. PCOS increases the risk for T2D. However, the risk for cardiovascular disease has not been quantified, and prospective, longitudinal studies are still critically needed.
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Affiliation(s)
- Laura C Torchen
- Division of Endocrinology, Ann & Robert H Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 54, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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22
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Boumosleh JM, Grundy SM, Phan J, Neeland IJ, Chang A, Vega GL. Metabolic Concomitants of Obese and Nonobese Women With Features of Polycystic Ovarian Syndrome. J Endocr Soc 2017; 1:1417-1427. [PMID: 29264465 PMCID: PMC5695651 DOI: 10.1210/js.2017-00323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/27/2017] [Indexed: 02/08/2023] Open
Abstract
Context: Polycystic ovarian syndrome (PCOS) is often associated with obesity and diabetes. Objective: The present study measured body fat distribution and metabolic risk factors in women with features of PCOS. Design: Cross-sectional, multiethnic study of cardiovascular risks. Setting: General community. Study Participants: 145 PCOS and 344 non-PCOS women. Exposure Measures: Body composition by dual x-ray absorptiometry; abdominal fat masses measured by magnetic resonance imaging and hepatic triglyceride by magnetic resonance spectroscopy. Outcomes Measures: Body composition, liver fat content, homeostatic model assessment for insulin resistance (HOMA-IR), revised, and metabolic syndrome components. Results: PCOS women had a higher free androgen index compared with the non-PCOS women. Nonobese PCOS and non-PCOS women had a similar body fat content and distribution, HOMA-IR, and hepatic triglyceride content. Obese PCOS women had a similar total body fat percentage compared with their non-PCOS counterparts (41.4% and 41.4% respectively). Both obese groups had similar intraperitoneal fat (1.4% of total body mass in PCOS vs 1.4% in non-PCOS). However, obese PCOS women had a greater ratio of truncal/lower body fat (1.42 vs 1.27; P < 0.016). They also had greater insulin resistance (HOMA-IR: PCOS, 2.24% vs non-PCOS, 1.91%; P < 0.016), higher liver triglyceride content (6.96% in PCOS vs 4.44% in non-PCOS; P < 0.016), and a greater incidence of hypertension (33% vs 24%; P < 0.05). No differences were observed in other metabolic risk factors. Conclusions: Both obese and nonobese women with PCOS features had a greater free androgen index compared with non-PCOS women, but neither had greater intraperitoneal fat or abnormal lipid levels. Obese, but not nonobese, women with PCOS had a greater truncal/lower extremity fat ratio, HOMA-IR, and liver triglyceride content.
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Affiliation(s)
- Jocelyne Matar Boumosleh
- The Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Scott M Grundy
- The Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390.,Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390.,Veterans Affairs Medical Center, Dallas, Texas 75216
| | - Jennifer Phan
- The Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Ian J Neeland
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Alice Chang
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Gloria Lena Vega
- The Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390.,Department of Clinical Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390.,Veterans Affairs Medical Center, Dallas, Texas 75216
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23
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Schiffer L, Kempegowda P, Arlt W, O’Reilly MW. MECHANISMS IN ENDOCRINOLOGY: The sexually dimorphic role of androgens in human metabolic disease. Eur J Endocrinol 2017; 177:R125-R143. [PMID: 28566439 PMCID: PMC5510573 DOI: 10.1530/eje-17-0124] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/12/2017] [Accepted: 05/03/2017] [Indexed: 12/22/2022]
Abstract
Female androgen excess and male androgen deficiency manifest with an overlapping adverse metabolic phenotype, including abdominal obesity, insulin resistance, type 2 diabetes mellitus, non-alcoholic fatty liver disease and an increased risk of cardiovascular disease. Here, we review the impact of androgens on metabolic target tissues in an attempt to unravel the complex mechanistic links with metabolic dysfunction; we also evaluate clinical studies examining the associations between metabolic disease and disorders of androgen metabolism in men and women. We conceptualise that an equilibrium between androgen effects on adipose tissue and skeletal muscle underpins the metabolic phenotype observed in female androgen excess and male androgen deficiency. Androgens induce adipose tissue dysfunction, with effects on lipid metabolism, insulin resistance and fat mass expansion, while anabolic effects on skeletal muscle may confer metabolic benefits. We hypothesise that serum androgen concentrations observed in female androgen excess and male hypogonadism are metabolically disadvantageous, promoting adipose and liver lipid accumulation, central fat mass expansion and insulin resistance.
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Affiliation(s)
- Lina Schiffer
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
| | - Punith Kempegowda
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Michael W O’Reilly
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
- Correspondence should be addressed to M W O’Reilly;
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24
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Zoet GA, Meun C, Benschop L, Boersma E, Budde RPJ, Fauser BCJM, de Groot CJM, van der Lugt A, Maas AHEM, Moons KGM, Roeters van Lennep JE, Roos-Hesselink JW, Steegers EAP, van Rijn BB, Laven JSE, Franx A, Velthuis BK. Cardiovascular RiskprofilE - IMaging and gender-specific disOrders (CREw-IMAGO): rationale and design of a multicenter cohort study. BMC WOMENS HEALTH 2017; 17:60. [PMID: 28784118 PMCID: PMC5547459 DOI: 10.1186/s12905-017-0415-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 08/01/2017] [Indexed: 01/30/2023]
Abstract
Background Reproductive disorders, such as polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI) and hypertensive pregnancy disorders (HPD) like pre-eclampsia (PE), are associated with an increased risk of cardiovascular disease (CVD). Detection of early signs of cardiovascular disease (CVD), as well as identification of risk factors among women of reproductive age which improve cardiovascular risk prediction, is a challenge and current models might underestimate long-term health risks. The aim of this study is to assess cardiovascular disease in patients with a history of a reproductive disorder by low-dose computed tomography (CT). Methods Women of 45 - 55 years, who experienced a reproductive disorder (PCOS, POI, HPD), are invited to participate in this multicenter, prospective, cohort study. Women will be recruited after regular cardiovascular screening, including assessment of classical cardiovascular risk factors. CT of the coronary arteries (both coronary artery calcium scoring (CACS), and contrast-enhanced coronary CT angiography (CCTA)) and carotid siphon calcium scoring (CSC) is planned in 300 women with HPD and 300 women with PCOS or POI. In addition, arterial stiffness (non-invasive pulse wave velocity (PWV)) measurement and cell-based biomarkers (inflammatory circulating cells) will be obtained. Discussion Initial inclusion is focused on women of 45 - 55 years. However, the age range (40 - 45 years and/or ≥ 55 years) and group composition may be adjusted based on the findings of the interim analysis. Participants can potentially benefit from information obtained in this study concerning their current cardiovascular health and expected future risk of cardiovascular events. The results of this study will provide insights in the development of CVD in women with a history of reproductive disorders. Ultimately, this study may lead to improved cardiovascular prediction models and will provide an opportunity for timely adjustment of preventive strategies. Limitations of this study include the possibility of overdiagnosis and the average radiation dose of 3.5 mSv during coronary and carotid siphon CT, although the increased lifetime malignancy risk is negligible. Trial registration Netherlands Trial Register, NTR5531. Date registered: October 21st, 2015.
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Affiliation(s)
- Gerbrand A Zoet
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, 3508, AB, Utrecht, The Netherlands.
| | - Cindy Meun
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Laura Benschop
- Department of Obstetrics & Gynaecology, University Medical Center Rotterdam, Erasmus MC, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine & Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Karl G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, University Medical Center Rotterdam, Erasmus MC, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Bas B van Rijn
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, 3508, AB, Utrecht, The Netherlands.,Academic Unit of Human Development and Health, University of Southampton, Princess Anne Hospital, Coxford Road, Southampton, SO16 5YA, UK
| | - Joop S E Laven
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Arie Franx
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, 3508, AB, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
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Abstract
Polycystic ovary syndrome (PCOS) affects 5-20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) - with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.
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Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ANDROGEN EXCESS AND PCOS SOCIETY DISEASE STATE CLINICAL REVIEW: GUIDE TO THE BEST PRACTICES IN THE EVALUATION AND TREATMENT OF POLYCYSTIC OVARY SYNDROME - PART 2. Endocr Pract 2016; 21:1415-26. [PMID: 26642102 DOI: 10.4158/ep15748.dscpt2] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Polycystic ovary syndrome (PCOS) is recognized as the most common endocrine disorder of reproductive-aged women around the world. This document, produced by the collaboration of the American Association of Clinical Endocrinologists and the Androgen Excess Society aims to highlight the most important clinical issues confronting physicians and their patients with PCOS. It is a summary of current best practices in 2014. Insulin resistance is believed to play an intrinsic role in the pathogenesis of PCOS. The mechanism by which insulin resistance or insulin give rise to oligomenorrhea and hyperandrogenemia, however, is unclear. Hyperinsulinemic-euglycemic clamp studies have shown that both obese and lean women with PCOS have some degree of insulin resistance. Insulin resistance is implicated in the ovulatory dysfunction of PCOS by disrupting the hypothalamic-pituitary-ovarian axis. Given the association with insulin resistance, all women with PCOS require evaluation for the risk of metabolic syndrome (MetS) and its components, including type 2 diabetes, hypertension, hyperlipidemia, and the possible risk of clinical events, including acute myocardial infarction and stroke. Obese women with PCOS are at increased risk for MetS with impaired glucose tolerance (IGT; 31 to 35%) and type 2 diabetes mellitus (T2DM; 7.5 to 10%). Rates of progression from normal glucose tolerance to IGT, and in turn to T2DM, may be as high as 5 to 15% within 3 years. Data suggest the need for baseline oral glucose tolerance test every 1 to 2 years based on family history of T2DM as well as body mass index (BMI) and yearly in women with IGT. Compared with BMI- and age-matched controls, young, lean PCOS women have lower high-density lipoprotein (HDL) size, higher very-low-density lipoprotein particle number, higher low-density lipoprotein (LDL) particle number, and borderline lower LDL size. Statins have been shown to lower testosterone levels either alone or in combination with oral contraceptives (OCPs) but have not shown improvement in menses, spontaneous ovulation, hirsutism, or acne. Statins reduce total and LDL cholesterol but have no effect on HDL, C-reactive protein, fasting insulin, or homeostasis model assessment of insulin resistance in PCOS women, in contrast to the general population. There have been no long-term studies of statins on clinical cardiac outcomes in women with PCOS. Coronary calcification is more prevalent and more severe in PCOS than in controls. In women under 60 years of age undergoing coronary angiography, the presence of polycystic ovaries on sonography has been associated with more arterial segments with >50% stenosis, but the relationship between PCOS and actual cardiovascular events remains unclear. Therapies for PCOS are varied in their effects and targets and include both nonpharmacologic as well as pharmacologic approaches. Weight loss is the primary therapy in PCOS--reduction in weight of as little as 5% can restore regular menses and improve response to ovulation- inducing and fertility medications. Metformin in premenopausal PCOS women has been associated with a reduction in features of MetS. Clamp studies using ethinyl estradiol/drosperinone combination failed to reveal evidence of an increase in either peripheral or hepatic insulin resistance. Subjects with PCOS have a 1.5-times higher baseline risk of venous thromboembolic disease and a 3.7-fold greater effect with OCP use compared with non-PCOS subjects. There is currently no genetic test to screen for or diagnose PCOS, and there is no test to assist in the choice of treatment strategies. Persistent bleeding should always be investigated for pregnancy and/or uterine pathology--including transvaginal ultrasound exam and endometrial biopsy--in women with PCOS. PCOS women can have difficulty conceiving. Those who become pregnant are at risk for gestational diabetes (which should be evaluated and managed appropriately) and the microvascular complications of diabetes. Assessment of a woman with PCOS for infertility involves evaluating for preconceptional issues that may affect response to therapy or lead to adverse pregnancy outcomes and evaluating the couple for other common infertility issues that may affect the choice of therapy, such as a semen analysis. Women with PCOS have multiple factors that may lead to an elevated risk of pregnancy, including a high prevalence of IGT--a clear risk factor for gestational diabetes--and MetS with hypertension, which increases the risk for pre-eclampsia and placental abruption. Women should be screened and treated for hypertension and diabetes prior to attempting conception. Women should be counseled about weight loss prior to attempting conception, although there are limited clinical trial data demonstrating a benefit to this recommendation. Treatment for women with PCOS and anovulatory infertility should begin with an oral agent such as clomiphene citrate or letrozole, an aromatase inhibitor.
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Chang AY, Oshiro J, Ayers C, Auchus RJ. Influence of race/ethnicity on cardiovascular risk factors in polycystic ovary syndrome, the Dallas Heart Study. Clin Endocrinol (Oxf) 2016; 85:92-9. [PMID: 26608823 PMCID: PMC4882287 DOI: 10.1111/cen.12986] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 08/25/2015] [Accepted: 11/20/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Polycystic ovarian syndrome (PCOS) is estimated to affect up to 20% of women. PCOS is associated with insulin resistance and cardiovascular (CV) risk factors. We aimed to evaluate the impact of race/ethnicity on the prevalence of CV risk factors and subclinical predictors of CV events. DESIGN Cross-sectional analysis of data collected by the Dallas Heart Study, an urban, population-based cohort oversampled for blacks. PATIENTS A previously described cohort of women with PCOS and control subjects of the same racial/ethnic group, matched for age and body mass index. MEASUREMENTS Hormonal and clinical measures associated with PCOS and CV risk factors. RESULTS The study included 117 women with PCOS and 204 controls. Women with PCOS had significant differences across racial/ethnic groups in the prevalence of hypertension, hypercholesterolaemia, hypertriglyceridaemia and impaired fasting glucose (P < 0·05). Controls showed significant racial/ethnic differences in the prevalence of hypertension and impaired fasting glucose (P < 0·05). The odds of hypertension were significantly greater among women with PCOS than controls after adjusting for race/ethnicity (odds ratio, 1·50 [95% CI, 1·03-2·30]; P = 0·04). However, we did not see an interaction of race/ethnicity that significantly changed CV risk factor prevalence between PCOS and controls. In addition, subclinical measures of CV disease were not different between women with PCOS vs controls, even among hypertensive women. CONCLUSIONS Race/ethnicity affects the prevalence of CV risk factors for women with and without PCOS. However, race/ethnicity does not interact with PCOS to additionally increase CV risk factor prevalence or subclinical CV disease.
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Affiliation(s)
- Alice Y Chang
- Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - June Oshiro
- Scientific Publications, Mayo Clinic, Rochester, MN, USA
| | - Colby Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Richard J Auchus
- Division of Metabolism, Diabetes, and Endocrinology, University of Michigan, Ann Arbor, MI, USA
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Regensteiner JG, Golden S, Huebschmann AG, Barrett-Connor E, Chang AY, Chyun D, Fox CS, Kim C, Mehta N, Reckelhoff JF, Reusch JEB, Rexrode KM, Sumner AE, Welty FK, Wenger NK, Anton B. Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation 2015; 132:2424-47. [PMID: 26644329 DOI: 10.1161/cir.0000000000000343] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Javed A, Lteif AN, Kumar S, Simmons PS, Chang AY. Fasting Glucose Changes in Adolescents with Polycystic Ovary Syndrome Compared with Obese Controls: A Retrospective Cohort Study. J Pediatr Adolesc Gynecol 2015; 28:451-6. [PMID: 26238569 PMCID: PMC4526446 DOI: 10.1016/j.jpag.2015.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 12/30/2014] [Accepted: 01/02/2015] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To compare changes in fasting glucose among adolescents with polycystic ovary syndrome (PCOS) with those in obese adolescents without PCOS. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 310 adolescents with PCOS and 250 obese adolescents (age range 13 to 18 years) seen at Mayo Clinic, Rochester, MN, from 1996 to 2012. METHODS Included for analysis were 98 adolescents with PCOS and 150 obese adolescents who had 2 or more fasting glucose measurements separated by at least 6 months. Adolescents with impaired fasting glucose (IFG) or diabetes were excluded. Multivariate models were used to assess predictors of change in fasting glucose. RESULTS At diagnosis, adolescents with PCOS had lower body mass index (BMI) (kg/m(2)) and older age than obese adolescents (P < .001). Adolescents with PCOS had shorter follow-up (P = .02). Baseline fasting glucose was not different between groups. Mean change in fasting glucose was 2.4 ± 9.4 mg/dL per year for PCOS and 2.2 ± 6.2 mg/dL per year for obese adolescents (P = .83). Significant predictors for change in fasting glucose were BMI and fasting glucose at diagnosis (P < .01). Within the PCOS cohort, BMI was a significant predictor for development of IFG (P = .003). Prevalence of hypertension increased in the PCOS cohort from baseline to follow-up (P = .02). PCOS and BMI were significantly associated with development of HTN in the entire cohort. CONCLUSION Adolescent girls with PCOS do not show a significant change in fasting glucose or an increased risk for the development of IFG compared with obese adolescents. BMI, not PCOS status, was the strongest predictor for changes in fasting glucose and development of IFG over time.
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Affiliation(s)
- Asma Javed
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Aida N Lteif
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patricia S Simmons
- Division of Pediatric and Adolescent Gynecology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alice Y Chang
- Division of Endocrinology, Department of Internal Medicine, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
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Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocr Rev 2015; 36:487-525. [PMID: 26426951 PMCID: PMC4591526 DOI: 10.1210/er.2015-1018] [Citation(s) in RCA: 520] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous and complex disorder that has both adverse reproductive and metabolic implications for affected women. However, there is generally poor understanding of its etiology. Varying expert-based diagnostic criteria utilize some combination of oligo-ovulation, hyperandrogenism, and the presence of polycystic ovaries. Criteria that require hyperandrogenism tend to identify a more severe reproductive and metabolic phenotype. The phenotype can vary by race and ethnicity, is difficult to define in the perimenarchal and perimenopausal period, and is exacerbated by obesity. The pathophysiology involves abnormal gonadotropin secretion from a reduced hypothalamic feedback response to circulating sex steroids, altered ovarian morphology and functional changes, and disordered insulin action in a variety of target tissues. PCOS clusters in families and both female and male relatives can show stigmata of the syndrome, including metabolic abnormalities. Genome-wide association studies have identified a number of candidate regions, although their role in contributing to PCOS is still largely unknown.
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Affiliation(s)
- Daniel A Dumesic
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Sharon E Oberfield
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Elisabet Stener-Victorin
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - John C Marshall
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Joop S Laven
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Richard S Legro
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
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Association of sex hormones with incident 10-year cardiovascular disease and mortality in women. Maturitas 2015; 82:424-30. [PMID: 26385535 DOI: 10.1016/j.maturitas.2015.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aims of this study were to ascertain whether women with high levels of serum total testosterone (TT) or low levels of sex hormone-binding globulin (SHBG) are more likely to develop cardiovascular disease (CVD), and to investigate potential associations between sex hormones and mortality (all-cause, as well as cause-specific) in the general population. STUDY DESIGN AND MAIN OUTCOME MEASURES Data on 2129 women with a mean age of 49.0 years were obtained from the population-based Study of Health in Pomerania over a median follow-up of 10.9 years. Associations of baseline levels of TT, SHBG, and rostenedione (ASD), and free testosterone (fT), and of the free androgen index (FAI), with follow-up CVD morbidity, as well as all-cause and CVD mortality, were analyzed using multivariable regression modeling. RESULTS At baseline the prevalence rate of CVD was 17.8% (378 women) and the incidence of CVD over the follow-up was 50.9 per 1000 person-years. We detected an inverse association between SHBG and baseline CVD in age-adjusted models (relative risk per standard deviation increase: 0.83; 95% confidence interval: 0.74-0.93). We did not detect any significant associations between sex hormone concentrations and incident CVD in age- and multivariable-adjusted Poisson regression models. Furthermore, none of the sex hormones (TT, SHBG, ASD, fT, FAI) were associated with all-cause mortality. CONCLUSIONS This population-based cohort study did not yield any consistent associations between sex hormones in women and incident CVD or mortality risk.
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Glueck CJ, Woo JG, Khoury PR, Morrison JA, Daniels SR, Wang P. Adolescent oligomenorrhea (age 14-19) tracks into the third decade of life (age 20-28) and predicts increased cardiovascular risk factors and metabolic syndrome. Metabolism 2015; 64:539-53. [PMID: 25633270 DOI: 10.1016/j.metabol.2015.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/22/2014] [Accepted: 01/06/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Assess whether adolescent oligomenorrhea (age 14-19) tracks into young adulthood (age 20-28) and predicts increased cardiometabolic risk factors, metabolic syndrome (MetS), and impaired fasting glucose-type II diabetes mellitus (IFG+T2DM). MATERIALS AND METHODS Prospective study of menstrual cyclicity and its metabolic effects in 865 black and white schoolgirls from age 9 to 19, and 605 of these 865 girls from age 20 to 28. MAIN FINDINGS Patterns of menstrual delays (oligomenorrhea) during ages 14-19 and ages 20-28 were closely related (p<.0001). Adolescent menses delay (ages 14-19, p<.0001), mean insulin (ages 20-28, p=.0003), and self-identified polycystic ovary syndrome (PCOS, p=.049) predicted ages 20-28 menses delay. Menses delays during ages 14-19 and 20-28, and, their interaction product were correlated with IFG+T2DM and MetS at ages 20-28. Waist circumference (ages 20-28, p<.0001), mean triglyceride (ages 20-28, p=.005), and the number of average menstrual cycles≥42 days (ages 20-28, p=.04) predicted IFG+T2DM (ages 20-28). MetS (ages 9-19, p<.0001), mean insulin (ages 20-28, p=.0002), the number of ≥42 day gaps between menstrual periods (ages 20-28, p=.02), and cigarette smoking at age 18-19 (p=.04) were significant explanatory variables for MetS at ages 27-28. As MetS status category changed from age 14-19 to 27-28 from best to worst: (no → no), (yes → no), (yes → yes), (no → yes), the number of women with ≥2 menses delays during ages 20-28 rose from 3% to 4% to 15% to 17%, p=.0001. MetS status change from age 9-19 to 27-28 was positively associated with mean insulin (age 20-28, p<.0001), cigarette smoking (age 24-25, p=.01) and the number of menses delays during ages 20-28 (p=.04). PRINCIPAL CONCLUSIONS Menstrual patterns track from adolescence to young adulthood, and oligomenorrhea predicts MetS and IFG+T2DM. Patterns of menses delays in adolescence should be considered as a significant risk factor for future development of young adult IFG+T2DM, MetS, oligomenorrhea, and polycystic ovary syndrome.
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Affiliation(s)
- Charles J Glueck
- Cholesterol Metabolism Thrombosis Center Jewish Hospital of Cincinnati, Cincinnati, OH.
| | - Jessica G Woo
- Heart Institute the Division of Biostatistics Epidemiology Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Philip R Khoury
- Heart Institute the Division of Biostatistics Epidemiology Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - John A Morrison
- Heart Institute the Division of Biostatistics Epidemiology Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Ping Wang
- Cholesterol Metabolism Thrombosis Center Jewish Hospital of Cincinnati, Cincinnati, OH
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Sanghavi M, Kulinski J, Ayers CR, Nelson D, Stewart R, Parikh N, de Lemos JA, Khera A. Association between number of live births and markers of subclinical atherosclerosis: The Dallas Heart Study. Eur J Prev Cardiol 2015; 23:391-9. [PMID: 25691547 DOI: 10.1177/2047487315571891] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/19/2015] [Indexed: 11/16/2022]
Abstract
AIMS Higher parity has been associated with increased maternal risk of cardiovascular disease, but the mechanism is not well delineated. Whether the number of live births is associated with coronary and aortic subclinical atherosclerosis has not been fully evaluated. METHODS AND RESULTS Women from the Dallas Heart Study, a multiethnic population-based cohort of subjects aged 30-65 years, were included if they had data on self-reported live births and coronary artery calcium (CAC) measured by computed tomography or aortic wall thickness (AWT) by MRI. Coronary artery calcium was positive if >10 Agatston units, and aortic wall thickness if greater than the 75(th) percentile reference point for age and gender. Among the 1644 women included in the study, the mean age was 45 years and 55% were Black. Sequential multivariable models were done adjusting for age, race, traditional cardiovascular risk factors, body mass index, income, education, hormone replacement therapy, oral contraceptives, and physical activity. Using women with 2-3 live births as the reference, those with four or more live births had an increased prevalence of elevated coronary artery calcium (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.28-3.65) and aortic wall thickness (OR 1.6, 95% CI 1.04-2.41). Women with 0-1 live births also had increased coronary artery calcium (OR 1.9, 95% CI 1.16-3.03) and aortic wall thickness (OR 1.5, 95% CI 1.05-2.09) after multivariable adjustment. CONCLUSION The number of live births is associated with subclinical coronary and aortic atherosclerosis, with an apparent U-shaped relationship. Further studies are needed to confirm this association and explore the biological underpinnings of these findings.
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Affiliation(s)
- Monika Sanghavi
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Colby R Ayers
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - David Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Robert Stewart
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Nisha Parikh
- Cardiovascular Division, University of California San Francisco, USA
| | - James A de Lemos
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Amit Khera
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
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Valderhaug T, Hertel J, Nordstrand N, Dale P, Hofsø D, Hjelmesæth J. The association between hyperandrogenemia and the metabolic syndrome in morbidly obese women. Diabetol Metab Syndr 2015; 7:46. [PMID: 26015809 PMCID: PMC4443598 DOI: 10.1186/s13098-015-0040-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/05/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Female abdominal obesity is associated with hyperandrogenemia (HA), but few studies have addressed the possible association between HA and metabolic syndrome (MetS) among obese women. Some studies indicate that insulin resistance may cause HA through different mechanisms. On the other hand, a bidirectional relationship between HA and insulin resistance has been suggested. Thus, we aimed to investigate if morbidly obese women with HA had higher odds of MetS and its components than those without HA (controls), independent of polycystic ovarian syndrome (PCOS) status. METHODS This cross-sectional study comprised 1900 consecutive treatment seeking morbidly obese women <50 years. Free testosterone index (FTI) >0.6 defined HA. Women with previously diagnosed PCOS and those with oligo- / anovulation combined with clinical or biochemical hyperandrogenism were defined as having PCOS. Multiadjusted associations between HA and MetS were assessed by logistic regression analysis. RESULTS Out of 1900 morbidly obese women, 1089 (57 %), 846 (45 %) and 312 (16 %) had MetS, HA and PCOS, respectively. Compared with controls (without HA), women with HA were younger (34 [1] years vs. 39 [2], p < 0.001) had a higher prevalence of MetS (62 % vs. 53 %, p < 0.001), type 2 diabetes (18 % vs. 15 %, p = 0.045), low HDL-cholesterol (65 % vs. 48 %, p < 0.001) and hypertriglyceridemia (48 % vs. 41 %, p = 0.004), but a lower prevalence of raised blood pressure (53 % vs. 59 %, p = 0.014). Multivariable analyses showed that HA was associated with increased odds of MetS (OR 1.61 [95 % CI 1.27, 2.02]), dysglycemia (1.65 [1.28, 2.11]), low HDL-cholesterol (1.58 [1.27, 1.97]), and hypertriglyceridemia (1.43 [1.15, 1.79]). After stratification for the presence of PCOS, the results remained largely unchanged in women without PCOS; MetS (1.52 [1.18, 1.96), dysglycemia (1.71 [1.30, 2.25]), low HDL-cholesterol (1.55 [1.22, 1.98]) and hypertriglyceridemia (1.36 [1.06, 1.74]). CONCLUSION Morbidly obese women with HA had an approximately 1.5-fold increased odds of having MetS even in the absence of PCOS. Randomized controlled clinical trials, including therapeutic strategies to lower free testosterone levels, are however necessary to explore any cause-and-effect relationship.
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Affiliation(s)
- T.G. Valderhaug
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- />Division of Medicine, Department of Endocrinology, Akershus University Hospital HF, Sykehusveien 25, 1478 Nordbyhagen, Norway
- />Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J.K. Hertel
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - N. Nordstrand
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - P.O. Dale
- />Department of Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - D. Hofsø
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - J. Hjelmesæth
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- />Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Paterakis TS, Diamanti-Kandarakis E. Aspects of Cardiometabolic Risk in Women with Polycystic Ovary Syndrome. Curr Obes Rep 2014; 3:377-86. [PMID: 26626914 DOI: 10.1007/s13679-014-0127-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Women with polycystic ovary syndrome (PCOS), the most common endocrine disorder among women of reproductive age, exhibit an adverse cardiovascular risk profile characteristic of the cardiometabolic syndrome. These women, compared with age- and body mass index-matched women without PCOS, appear to present a higher risk of insulin resistance, glucose intolerance, and dyslipidemia, and possibly a higher rate of type 2 diabetes mellitus and cardiovascular disease. However, despite the presence of cardiovascular risk factors and increased surrogate markers of cardiovascular disease, it is unclear whether they have accelerated atherosclerosis and greater mortality, the latter mainly because of a lack of endpoint studies. This article addresses, summarizes, and discusses salient data from the existing literature, including gaps and uncertainties, aspects, and mechanisms related to the spectrum of adverse cardiometabolic profile factors in women with PCOS.
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Affiliation(s)
| | - Evanthia Diamanti-Kandarakis
- Sotiria Hospital, Medical School-University of Athens, Mesogeion 152, Athens, Greece.
- University of Athens, Medical School, 1A Zefyrou, 145 78, Athens, Greece.
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Calderon-Margalit R, Siscovick D, Merkin SS, Wang E, Daviglus ML, Schreiner PJ, Sternfeld B, Williams OD, Lewis CE, Azziz R, Schwartz SM, Wellons MF. Prospective association of polycystic ovary syndrome with coronary artery calcification and carotid-intima-media thickness: the Coronary Artery Risk Development in Young Adults Women's study. Arterioscler Thromb Vasc Biol 2014; 34:2688-94. [PMID: 25359859 DOI: 10.1161/atvbaha.114.304136] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To study the independent associations of polycystic ovary syndrome (PCOS), and its 2 components, hyperandrogenism and anovulation, with coronary artery calcification (CAC) and carotid artery intima-media thickness (IMT). APPROACH AND RESULTS At the year 20 of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based multicenter cohort of young adults, women (mean age, 45 years) with information on menses and hirsutism in their twenties were assessed for CAC (n=982) and IMT (n=988). We defined PCOS as women who had both irregular menses and hyperandrogenism (n=55); isolated oligomenorrhea (n=103) as women who only had irregular menses; and isolated hyperandrogenism (n=156) as women who had either hirsutism or increased testosterone levels. Logistic regressions and general linear models were used to estimate the associations between components of PCOS and subclinical CVD. The prevalence of CAC was 10.3% overall. Women with PCOS had a multivariable adjusted odds ratio of 2.70 (95% confidence interval, 1.31-5.60) for CAC. Women with either isolated oligomenorrhea or isolated hyperandrogenism had no increased risk of CAC when compared with unexposed women. Women with PCOS had significantly increased bulb and internal carotid-IMT measurements; however, no significant differences were noted in bulb or internal carotid artery IMT among women with either isolated oligomenorrhea or isolated hyperandrogenism when compared with unexposed women. There were no differences in common carotid-IMT among the 4 study groups. CONCLUSIONS In this study, women with PCOS, manifested as both anovulation and hyperandrogenism, but not women with one of these manifestations alone, were at increased risk for the development of subclinical CVD.
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Affiliation(s)
- Ronit Calderon-Margalit
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.).
| | - David Siscovick
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Sharon S Merkin
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Erica Wang
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Martha L Daviglus
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Pamela J Schreiner
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Barbara Sternfeld
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - O Dale Williams
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Cora E Lewis
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Ricardo Azziz
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Stephen M Schwartz
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Melissa F Wellons
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
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Dokras A. Cardiovascular disease risk in women with PCOS. Steroids 2013; 78:773-6. [PMID: 23624351 DOI: 10.1016/j.steroids.2013.04.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 01/07/2023]
Abstract
Cardiac disease is the number one killer in women. Adolescents and reproductive age women with PCOS have an increased prevalence of cardiovascular risk factors. These include obesity, impaired glucose tolerance, diabetes, hypertension, mood disorders and metabolic syndrome. There is sufficient evidence to confirm the presence of subclinical atherosclerosis in women with PCOS compared to age matched controls. There are, however, few prospective studies examining non-fatal and fatal cardiac events in women with well-defined PCOS. Future directions of research should include longitudinal studies in peri- and post-menopausal women with prospectively defined PCOS to better estimate the risk of cardiac morbidity and mortality in this high-risk population. In the meantime, regular screening for risk factors and timely early interventions are critical to reduce the overall risk burden.
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Affiliation(s)
- Anuja Dokras
- Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 800, Philadelphia, PA 19104, USA.
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Mani H, Levy MJ, Davies MJ, Morris DH, Gray LJ, Bankart J, Blackledge H, Khunti K, Howlett TA. Diabetes and cardiovascular events in women with polycystic ovary syndrome: a 20-year retrospective cohort study. Clin Endocrinol (Oxf) 2013; 78:926-34. [PMID: 23046078 DOI: 10.1111/cen.12068] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 08/16/2012] [Accepted: 10/04/2012] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Women with polycystic ovary syndrome (PCOS) are potentially at increased risk of cardiovascular (CV) diseases due to well-established risk factors, including insulin resistance, obesity and type 2 diabetes mellitus (T2DM). However, data showing excess CV events in this population are still lacking. We investigated the incidence and prevalence of CV events in a cohort of women with PCOS. DESIGN Retrospective cohort study (total follow-up >12,000 person-years). SETTING Leicester, Leicestershire and Rutland (Total Female population of 434,859), UK. PARTICIPANTS Two thousand three hundred and one women with PCOS (mean age = 29.6 years) attending a speciality clinic in Leicestershire, UK. MAIN OUTCOMES MEASURES T2DM, myocardial infarction (MI), angina, heart failure (HF), stroke and CV-related death. RESULTS Incidence of T2DM, MI, angina, HF, stroke and CV death was respectively 3.6, 0.8, 1.0, 0.3, 0.0 and 0.4 per 1000 person-years. At the end of follow-up, the prevalence of MI in the age groups 45-54, 55-64 and >65 years was 1.9%, 6.0% and 27.3% and of angina was 2.6%, 6.0% and 27.3%, respectively. Age-group-specific odds ratios for the prevalence of MI and angina compared to the local female population ranged between 2.6 (95% CI: 1.0-6.3) and 12.9 (CI: 3.4-48.6) with the highest ratio being for MI in the group >65 years old. Age, history of hypertension and smoking had significant correlations with CV outcomes in the PCOS patients. CONCLUSION We have shown a high incidence and age-group-specific prevalence of T2DM, MI and angina in the women with PCOS, with over a quarter having had MI or angina in those >65 years. These findings should be considered in the treatment strategies and long-term planning for women with PCOS.
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Affiliation(s)
- Hamidreza Mani
- Department of Cardiovascular Sciences, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
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Du Q, Yang S, Wang YJ, Wu B, Zhao YY, Fan B. Effects of thiazolidinediones on polycystic ovary syndrome: a meta-analysis of randomized placebo-controlled trials. Adv Ther 2012; 29:763-74. [PMID: 22932791 DOI: 10.1007/s12325-012-0044-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Thiazolidinedione (TZD) is one of the therapy options for polycystic ovary syndrome (PCOS) patients; however, the effectiveness of TZD in the treatment of PCOS remains controversial. The aim of this metaanalysis was to clarify the role that TZDs play in the treatment of PCOS. METHODS The authors searched the following databases for any date up to June 2012 for randomized controlled trials on PCOS treatment in which interventions for the experimental and control groups were TZDs and placebo, respectively: Medline, Embase, and the Cochrane library. RESULTS The search strategy identified 173 potential publications, eight of which were included. In the treatment of PCOS, the insulin-lowering effects of TZDs were superior to placebo (95% CI -1.50 to -0.12; P=0.021), and the lowering of fasting blood glucose was superior to placebo (95% CI -1.06 to -0.05; P=0.031). There was no difference in reduction of the Ferriman-Gallwey scores or the androgen levels between TZDs and placebo (95% CI -0.57 to 0.10; P=0.169 and 95% CI -0.64 to 0.09; P=0.141, respectively). The effects of TZDs on body weight reduction were inferior to placebo (95% CI 0.13 to 0.66; P=0.003). Significant between-study heterogeneity was detected for several variables assessed. CONCLUSION This is the first meta-analysis to evaluate the role that TZDs plays in the treatment of PCOS compared with placebo. The currently available data showed that TZDs can effectively reduce insulin and fasting blood glucose levels in patients with PCOS, but TZDs may not effectively reduce the Ferriman-Gallwey score or androgen levels and may increase body weight.
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Abstract
Polycystic ovary syndrome (PCOS) has been associated with increased cardiovascular risk (CVR) markers, but population studies have not clarified whether there is an increase in cardiovascular morbidity and mortality. Four different PCOS phenotypes resulted from the Rotterdam criteria that may differ in their CVR potential, thus introducing further complexity. This has led to studies using surrogate CVR markers including biomarkers in blood and imaging such as flow-mediated vasodilatation. In PCOS, both peripheral and central insulin resistance (IR) have been shown. Weight loss has been shown to improve IR and visceral fat, while insulin sensitizer therapies with metformin or thiazolidinediones improve IR and endothelial dysfunction. IR is also found in non-alcoholic fatty liver disease that in turn is very common in PCOS; studies have suggested that IR may be improved by treatment with metformin and omega-3 fish oils. PCOS patients have a more dyslipidemic phenotype that is worse in 'classical PCOS' associated with a higher CVR. Studies with atorvastatin and simvastatin have reported a decrease in the lipid parameters and an improvement in CVR indices including IR, but it is unclear whether this is due to their lipid-lowering action or a pleiotropic effect of the statin. In this expert opinion review, the relevant literature published during the last 2 years was considered. It focuses on some recent important data that has emerged while also exposing the gaps that remain in our knowledge that need to be addressed.
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Affiliation(s)
- T Sathyapalan
- Hull York Medical School, Academic Endocrinology, Diabetes and Metabolism, Michael White Diabetes Centre, 220-236 Anlaby Road, Hull, UK.
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Duleba AJ, Dokras A. Is PCOS an inflammatory process? Fertil Steril 2012; 97:7-12. [PMID: 22192135 DOI: 10.1016/j.fertnstert.2011.11.023] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/17/2011] [Accepted: 11/17/2011] [Indexed: 11/18/2022]
Abstract
PRO--PCOS is associated with low-grade systemic inflammation as evidenced by elevation of multiple markers of inflammation such as C-reactive protein, interleukin-18, monocyte chemoattractant protein-1 and white blood cell count as well as endothelial dysfunction and increased oxidative stress. CON--Current studies examining the evidence for low grade inflammation in PCOS are small, heterogeneous for the diagnosis, confounded by degree of adiposity and do not consistently demonstrate a clinically relevant increase in the above mentioned biomarkers.
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Affiliation(s)
- Antoni J Duleba
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, California 95817, USA.
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Dilbaz B, Ozkaya E, Cinar M, Cakir E, Dilbaz S. Cardiovascular disease risk characteristics of the main polycystic ovary syndrome phenotypes. Endocrine 2011; 39:272-7. [PMID: 21547513 DOI: 10.1007/s12020-011-9437-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 02/02/2011] [Indexed: 11/27/2022]
Abstract
The aim of this article was to evaluate the clinical, endocrine, and cardiovascular disease risk profile differences among main polycystic ovary syndrome (PCOS) phenotypes. One hundred and thirty-nine consecutive women were included in the study. Body mass index (BMI), serum follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone, estradiol, testosterone, dehydroepiandrosterone sulfate, fasting glucose, low density lipoprotein (LDL-C), total cholesterol, high density lipoprotein (HDL-C) high sensitive CRP, c-peptide, insulin, insulin sensitivity and carotid intima thickness were compared among different phenotype groups of PCOS: Group 1-PCO (polycystic ovaries)-anovulation (n = 34), Group 2-Hyperandrogenemia (HA)-anovulation (n = 30), Group 3-HA-PCO (n = 32), and Group 4-HA-PCO-anovulation (n = 43). Statistically significant differences among the different phenotype groups in terms of waist hip ratio, total cholesterol, LH, estradiol, fasting glucose, progesterone, free testosterone, and carotid intima media thickness were observed. The lowest mean CIMT was observed in Group 3, and the highest fasting glucose levels were in Group 4, while the lowest mean free testesterone was measured in Group 1. BMI, LDL-C, and total cholesterol showed significant positive correlations with CIMT (r = 0.411, P = 0.001; r = 0.258, P = 0.006; r = 0.199, P = 0.033). The lowest LDL-C, total cholesterol, and BMI were found in Group 3, but differences were not statistically significant. High-sensitive CRP levels were similar among the groups (P = 0.103). Group 3 PCOS with PCO and hyperandrogenemia phenotype has lower cardiovascular disease risk compared to other phenotypes.
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Affiliation(s)
- Berna Dilbaz
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity & Women's Health Teaching and Research Hospital, Ankara, Turkey
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