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Lee I, Vresilovic J, Irfan M, Gallop R, Dokras A. Higher Incidence of Metabolic Syndrome in Black Women With Polycystic Ovary Syndrome: A Longitudinal Study. J Clin Endocrinol Metab 2022; 107:e1558-e1567. [PMID: 34928388 DOI: 10.1210/clinem/dgab840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Cross-sectional studies have identified an increased risk of metabolic syndrome (MetSyn) in women with polycystic ovary syndrome (PCOS), but longitudinal data are limited and primarily include White and European cohorts. OBJECTIVE To compare the longitudinal risk of MetSyn in Black and White women with PCOS and to identify potential factors mediating the risk of MetSyn. METHODS Longitudinal cohort study with a follow-up of 5.3 years at an academic medical center. OF 247 adult women with hyperandrogenic PCOS phenotype with 2 or more visits at least 3 years apart. The main outcome measure was incidence of MetSyn in Black and White women with PCOS. RESULTS Using a mixed-effects model over time, the incidence of MetSyn was higher in Black women (45.9 ± 4.74 per 100 person-years) than in White women (31.3 ± 3.03 per 100 person-years) (P < .01) after adjusting for age and medication status. This difference persisted among women under age 30. Among Black women who did not have MetSyn at their prior visit, 28.0% had MetSyn at the next visit, compared with 12.1% of White women after adjusting for age and medication status (P < .01). In both races, the model-based estimated rates of MetSyn increased significantly with increase in body mass index and free testosterone. CONCLUSION We describe a persistent higher incidence of MetSyn in Black than in White women with PCOS. In addition to early cardiometabolic screening at the time of diagnosis, our findings highlight the need for ongoing and frequent screening in this population.
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Affiliation(s)
- Iris Lee
- Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA 19104, USA
| | - Julia Vresilovic
- Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA 19104, USA
| | - Maryam Irfan
- Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA 19104, USA
| | - Robert Gallop
- Department of Biostatistics, University of Pennsylvania; Philadelphia, PA 19104, USA
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA 19104, USA
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Persson S, Elenis E, Turkmen S, Kramer MS, Yong EL, Poromaa IS. Higher risk of type 2 diabetes in women with hyperandrogenic polycystic ovary syndrome. Fertil Steril 2021; 116:862-871. [PMID: 34053678 DOI: 10.1016/j.fertnstert.2021.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the risk of type 2 diabetes (T2D) in women with polycystic ovary syndrome (PCOS) in relation to body mass index (BMI) and the hyperandrogenic (HA) PCOS phenotype. DESIGN Population-based cohort study. SETTING Data from six Swedish national registers, with participants being followed for a maximum of 19 years. PATIENT(S) All women with an International Statistical Classification of Diseases and Related Health Problems, version 10, diagnosis of PCOS, androgen excess, or anovulatory infertility born between 1950 and 1999 (n = 52,535) were identified in the Patient Register. The HA PCOS phenotype was defined by two filled prescriptions for anti-androgenic drugs. For each woman with PCOS, five control women (n = 254,624) were randomly chosen from the Total Population Register, matched for age and geographic area. INTERVENTION(S) No interventions were performed. MAIN OUTCOME MEASURE(S) International Statistical Classification of Diseases and Related Health Problems, version 10, diagnosis of T2D or prescription of antidiabetic treatment other than metformin. RESULT(S) The cumulative incidence rates of T2D were 1.3%, 4.4%, and 14.2% in controls (non-PCOS women) and women with normoandrogenic (NA) and HA PCOS, respectively. After adjustment for BMI, women with PCOS had a twofold higher rate of T2D than non-PCOS women (adjusted hazard ratio, 2.52 [95% confidence interval, 2.15-2.96]). Women with HA PCOS had a higher rate of T2D than those with NA PCOS (adjusted hazard ratio, 3.86 [95% confidence interval, 3.16-4.72]). CONCLUSION(S) Polycystic ovary syndrome is an independent risk factor for T2D, even after adjustment for BMI. Women with the HA PCOS phenotype face an even higher risk of T2D than those with the NA PCOS phenotype.
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Affiliation(s)
- Sofia Persson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Obstetrics and Gynecology, Sundsvall County Hospital, Sundsvall, Sweden.
| | - Evangelia Elenis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sahruh Turkmen
- Department of Clinical Sciences, Obstetrics and Gynecology, Sundsvall Research Unit, Umeå University, Umeå, Sweden; Department of Obstetrics and Gynecology, Sundsvall County Hospital, Sundsvall, Sweden
| | - Michael S Kramer
- Departments of Epidemiology, Biostatistics and Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, Singapore
| | - Eu-Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, Singapore
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Yang S, Dai H, Hu W, Geng S, Li L, Li X, Liu H, Liu D, Li K, Yang G, Yang M. Association between circulating follistatin-like-1 and metabolic syndrome in middle-aged and old population: A cross-sectional study. Diabetes Metab Res Rev 2021; 37:e3373. [PMID: 32592413 DOI: 10.1002/dmrr.3373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022]
Abstract
AIM Follistatin-like-1 (FSTL-1) is considered to be a novel cytokine, and it is associated with metabolic diseases. However, it is necessary to investigate further the association of FSTL-1 with metabolic syndrome (MetS) and insulin resistance (IR). We performed a cross-sectional study to investigate the associated of circulating FSTL-1 with the MetS. MATERIALS AND METHODS A cross-sectional study was performed in 487 Chinese people, including 231 control subjects and 256 patients with MetS. Bioinformatics analysis was used to determine the protein and pathways associated with FSTL-1. The protein and protein interaction (PPI) network was constructed and analysed. Serum FSTL-1 concentrations were determined by an ELISA assay. The association of FSTL-1 with MetS components and IR was assessed. RESULTS Serum FSTL-1 levels were markedly higher in patients with newly diagnosed MetS than in controls (7.5 [5.6-9.2] vs 5.8 [5.0-7.7] μg/L, P < .01). According to bioinformatics analysis, the top high-degree genes were identified as the core genes, including SPARCL1, CYR61, LTBP1, IL-6, BMP2, BMP4, FBN1, FN1 CHRDL1 and FSTL-3. These genes are mainly enriched in pathways including TGF-ß, AGE-RAGE signalling pathway in diabetic complications, and Hippo signalling pathways; in basal cell carcinoma, cytokine-cytokine receptor interaction and in amoebic and Yersinia infections. Furthermore, serum FSTL-1 levels were positively associated with fasting plasma glucose (FPG), waist circumference (WC), blood pressure, triglyceride levels and visceral adiposity index (VAI). We found that serum FSTL-1 levels were markedly associated with MetS and IR by binary logistic regression analysis. CONCLUSIONS We conclude that FSTL-1 may be a novel cytokine related to MetS and IR.
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Affiliation(s)
- Shan Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Han Dai
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Wenjing Hu
- Department of Endocrinology, Chongqing Prevention and Treatment Hospital for Occupational Diseases, Chongqing, China
| | - Shan Geng
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ling Li
- Key Laboratory of Diagnostic Medicine (Ministry of Education) and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Xinrun Li
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hua Liu
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Dongfang Liu
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ke Li
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Mengliu Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Hu W, Zhan B, Li Q, Yang G, Yang M, Tan M, Geng S, Liu H, Chen C, Liu D, Li L. Circulating CTRP7 Is a Potential Predictor for Metabolic Syndrome. Front Endocrinol (Lausanne) 2021; 12:774309. [PMID: 34867822 PMCID: PMC8636004 DOI: 10.3389/fendo.2021.774309] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Previous animal studies have revealed that CTRP7 is related to energy metabolism. However, little is known regarding the relationship between CTRP7 and metabolic diseases in humans. Hence, this study was designed to explore the association between CTRP7 and MetS through a cross-sectional study and multiple intervention studies. METHODS A total of 624 individuals were enrolled in this study. The levels of CTRP7 and APN were determined by ELISA kit. HEC, OGTT and lipid infusion were performed in heathy individuals to investigate the association of CTRP7 and glucose, insulin and FFA. Bioinformatics analysis was then undertaken to identify genes and signaling pathways associated with CTRP7. The relationship between CTRP7 with MetS components was also evaluated. RESULTS In MetS patients, serum CTRP7 concentrations were significantly higher than in healthy controls, and was positively correlated with WC, BP, FBG, 2h-BG and TG, but negatively correlated with HDL-C and APN. Multivariate logistic regression analysis uncovered that CTRP7 was strongly correlated with the occurrence of MetS. In addition, circulating levels of CTRP7 in patients with two or more MetS components were higher than those with one MetS component. In the intervention studies, OGTTs resulted in a significant reduction in serum CTRP7 concentration. However, the increase in insulin levels caused by EHC and the increase of FFA caused by lipid-infusion led to the significant increase of serum CTRP7 concentration. Meanwhile, bioinformatics analysis revealed that CTRP7 was strongly associated with metabolism-related genes and signal pathways, which further illustrate the association of CTRP7 with whole-body metabolism. CONCLUSIONS Serum CTRP7 is increased in MetS patients, which may be a biomarker related to metabolic diseases. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR2000032878.
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Affiliation(s)
- Wenjing Hu
- Key Laboratory of Diagnostic Medicine (Ministry of Education) and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Bin Zhan
- Department of Endocrinology, The Thirteenth People’s Hospital of Chongqing, Chongqing, China
| | - Qinge Li
- Key Laboratory of Diagnostic Medicine (Ministry of Education) and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Mengliu Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Minghong Tan
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Shan Geng
- Department of Endocrinology, The Thirteenth People’s Hospital of Chongqing, Chongqing, China
| | - Hua Liu
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Chen Chen
- Endocrinology, School of Biomedical Science (SBMS), Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Dongfang Liu
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ling Li
- Key Laboratory of Diagnostic Medicine (Ministry of Education) and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, China
- *Correspondence: Ling Li,
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Meyer ML, Sotres‐Alvarez D, Steiner AZ, Cousins L, Talavera GA, Cai J, Daviglus ML, Loehr LR. Polycystic Ovary Syndrome Signs and Metabolic Syndrome in Premenopausal Hispanic/Latina Women: the HCHS/SOL Study. J Clin Endocrinol Metab 2020; 105:5698885. [PMID: 31917455 PMCID: PMC7007876 DOI: 10.1210/clinem/dgaa012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS), a condition of androgen excess in women, is associated with cardiometabolic risk factors; however, this association is not fully characterized in a population-based sample of premenopausal women and high-risk groups such as Hispanics/Latinas. OBJECTIVE We examined the association of PCOS signs and metabolic syndrome (MetS) in premenopausal Hispanic/Latina women. METHODS This cross-sectional analysis includes 1427 women age 24 to 44 years from the Hispanic Community Health Study/Study of Latinos. PCOS signs included menstrual cycle greater than 35 days or irregular, self-reported PCOS, and oral contraceptive use to regulate periods or acne, and a composite of 1 or more PCOS signs. We calculated odds ratios (OR) and 95% CI for MetS, accounting for sociodemographic factors and the complex survey design; an additional model included body mass index (BMI). RESULTS The mean age was 34 years and 30% reported any PCOS sign. The odds of MetS were higher in women reporting cycles greater than 35 days or irregular (OR 1.63; CI: 1.07-2.49) vs cycles 24 to 35 days, self-reported PCOS (OR 2.49; CI: 1.38-4.50) vs no PCOS, and any PCOS sign (OR 1.58; CI: 1.10-2.26) vs none. We found no association between OC use to regulate periods or acne and MetS (OR 1.1; CI: 0.6-1.8). When adjusting for BMI, only the association of self-reported PCOS and MetS was attenuated (OR 1.78; CI: 0.92-3.44). CONCLUSIONS In Hispanic/Latina women, irregular menstrual cycles, self-reported PCOS, and any PCOS sign were associated with MetS and could indicate women at metabolic disease risk.
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Affiliation(s)
- Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Correspondence: Michelle L. Meyer, PhD, MPH, University of North Carolina Chapel Hill, Department of Emergency Medicine, 170 Manning Drive, Campus Box 7594, Chapel Hill, North Carolina 27599-7594. E-mail:
| | | | - Anne Z Steiner
- Department of Obstetrics and Gynecology, Duke University, Duke, North Carolina
| | - Larry Cousins
- Children’s Specialists of San Diego, San Diego, California
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, California
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina-Chapel Hill, North Carolina
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois
| | - Laura R Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Abstract
Polycystic ovary syndrome (PCOS), characterized by hormonal imbalance and ovarian dysfunction, often starts during adolescence. Inconsistent diagnostic criteria, variable provider knowledge, and lack of consensus pose specific challenges for the care of women with PCOS. These factors encourage inaccurate diagnosis with both under and overdiagnosis. This unfavorable diagnostic experience exasperates affected women and limits timely opportunities for intervention to minimize associated comorbidities, especially during the transition from pediatric to adult care. Recognition of these issues in the care of adolescents and women with PCOS inspired the development of the International Evidence-Based PCOS Guidelines, which emphasize the prevention, screening, and treatment of PCOS across the reproductive lifespan. The Guidelines and accompanying meta-analyses focus on three major categories of associated comorbidities: (1) reproductive; (2) metabolic; and (3) psychological. With the exception of infertility, this article considers common manifestations and comorbidities associated with PCOS throughout the lifecycle. Healthy lifestyle interventions with prevention of excess weight gain comprise the primary intervention for all comorbidities. Hence, early identification of girls "at risk" for PCOS and those with PCOS is a priority. Extensive guidelines for provider and patient education aim to decrease the medical, psychosocial, and economic burdens attributable to PCOS and its associated comorbidities.
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