Adolescents with Classical Polycystic Ovary Syndrome Have Alterations in the Surrogate Markers of Cardiovascular Disease but Not in the Endothelial Function. The Possible Benefits of Metformin

Abstract

Study Objective To study whether adolescents with the classical form of polycystic ovary syndrome have alterations in metabolic and vascular structure and function. The effect of metformin was evaluated. Design Controlled study Setting University outpatient clinic Participants Eighteen PCOS non obese adolescents were enrolled. Seventeen healthy age-matched adolescents were recruited as controls. Interventions The metabolic profile and the endothelial structure and function were evaluated. Main Outcome Measure(s) Hormonal and lipid profile, blood pressure (BP) measurement, fasting glucose and insulin levels, C-reactive protein (CRP), homocysteine, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and plasmin-antiplasmin complexes (PAP) were measured. Flow mediated dilation (FMD), central pulse wave velocity (PWV), radial artery pulse wave (AIx) and common carotid intima-media thickness (IMT) were also assessed. PCOS girls were also studied 6 months after treatment with metformin (850 mg bid). Results PCOS adolescents were insulin resistant and/or hyperinsulinemic and they had higher BP values and levels of CRP and PAI-1 than the controls. The levels of t-PA and PAP were similar in both groups. FMD, PWV and IMT were also similar. Metformin significantly (p<0.05) reduced insulin, BP, CRP and PAI-1 levels. The PAP levels significantly (p<0.05) increased. Radial AIx was significantly reduced after metformin. No modifications in FMD, PWV and IMT were observed. Conclusions Adolescents with classical PCOS have alterations in some surrogate markers of cardiovascular risk and they are ameliorated by metformin. No deterioration of vascular structure and function has been detected, probably due to the short duration of exposure to the disease.

Micronutrients in support to the one carbon cycle for the modulation of blood fasting homocysteine in PCOS women

“…PCOS may also be associated with increased incidence of cardiovascular disease and this risk should be considered even in young women with PCOS [11]. Surrogate markers of cardiovascular disease are already altered in adolescent PCOS ladies and metformin treatment positively modified these markers leading to the proposal of a preventive treatment [12]. However, the impairment of Hcy metabolism resulting from metformin treatment [5,6] may lead to the opposite long-term outcomes.…”

Does cardiovascular risk vary according to the criteria for a diagnosis of polycystic ovary syndrome?

“…Radial and aortic augmentation indices were found to be similar between PCOS and non‐PCOS patients. FMD has been found to be similar between PCOS and non‐PCOS groups in some studies; however, increased FMD was also reported in a PCOS group in another study . Serum testosterone levels were higher in the PCOS groups in some of these studies and free androgen index was higher in others when compared to controls.…”

“…Endotelial dysfunction has been investigated in PCOS patients using different methods. Although some studies have not shown any differences between PCOS and non‐PCOS women using central and peripheral pulse wave velocities, others have reported differences . Radial and aortic augmentation indices were found to be similar between PCOS and non‐PCOS patients.…”

“…Although some studies have not shown any differences between PCOS and non‐PCOS women using central and peripheral pulse wave velocities, others have reported differences . Radial and aortic augmentation indices were found to be similar between PCOS and non‐PCOS patients. FMD has been found to be similar between PCOS and non‐PCOS groups in some studies; however, increased FMD was also reported in a PCOS group in another study .…”

Polycystic ovary syndrome (PCOS) and the accompanying disorders of glucose homeostasis among girls at the time of puberty

“…The possibility of making the diagnosis of PCOS is controversial if a patient is adolescent. In fact, the same criteria (anovulation, hyperandrogenism, and polycystic ovaries) that are used for the diagnosis in adults, in adolescents may be transitory or within evolution [22].…”