Body mass index rather than the phenotype impacts precocious ultrasound cardiovascular risk markers in polycystic ovary syndrome

Abstract

Research into cardiovascular disease (CV) prevention has demonstrated a variety of ultrasound (US) markers predicting risk in the general population, but which have been scarcely used for polycystic ovary syndrome (PCOS). Obesity is a major factor contributing to CV disease in the general population, and it is highly prevalent in PCOS. However, it is still unclear how much risk is attributable to hyperandrogenism. This study evaluates the most promising US CV risk markers in PCOS and compares them between different PCOS phenotypes and BMI values. Women fulfilling the Rotterdam criteria for PCOS were recruited from our outpatient clinic for this cross-sectional study. Participants (n = 102) aged 38.9±7.4 years were stratified into the four PCOS phenotypes and the three BMI classes (normal-weight, overweight, obese). They were assessed for clinical and biochemical parameters together with the following US markers: coronary intima-media thickness (cIMT), flow-mediated vascular dilation (FMD), nitroglycerine-induced dilation (NTG), and epicardial fat thickness (EFT). There was no statistical difference among the four phenotypes in terms of cIMT, FMD, NTG or EFT, however all the US parameters except NTG showed significant differences among the three BMI classes. Adjusting for confounding factors in multiple regression analyses, EFT retained the greatest direct correlation with BMI, and cIMT remained directly correlated but to a lesser degree. This study showed that obesity rather than the hyperandrogenic phenotype negatively impacts precocious US CV risk markers in PCOS. In addition, EFT showed the strongest association with BMI, highlighting its potential for estimating CV risk in PCOS.

Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion

“…9 Obesity further exacerbates hyperandrogenism and hyperinsulinemia and plays a key independent role in increasing cardiometabolic risks in women with PCOS. 10,11 Women with PCOS commonly have oligo/anovulation, with or without irregular menstrual cycles, 12,13 with PCOS the most common cause of anovulatory infertility. 14 Infertility and a longer time to pregnancy may confer a higher risk for pregnancy and birth complications.…”

“…and may be inter‐related to the psychological features of PCOS such as anxiety, depression, and poor quality of life 9 . Obesity further exacerbates hyperandrogenism and hyperinsulinemia and plays a key independent role in increasing cardiometabolic risks in women with PCOS 10,11 …”