Cardiovascular autonomic dysfunction in women with polycystic ovary syndrome: a systematic review and meta-analysis

Gui, Juan; Wang, Ruihao

doi:10.1016/j.rbmo.2017.03.018

Cited by 16 publications

(12 citation statements)

References 59 publications

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“…Epidemiological literature shows that women with PCOS have an increased prevalence of cardiometabolic complications, such as hyperlipemia, hypertension, type 2 diabetes and metabolic syndrome [3]. Although the exact etiology of PCOS has not been elucidated yet, imbalance of autonomic nervous system is con rmed as a key contributor for reproductive disorders and cardiometabolic outcomes by accumulating clinical researches [4].…”

Section: Introductionmentioning

confidence: 99%

Association Between Circulating Adiponectin and Heart Rate Recovery in Women With Polycystic Ovarian Syndrome

Zheng¹,

Feng

et al. 2021

Preprint

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Background: Imbalance of autonomic nervous system is confirmed as a key contributor for cardiometabolic complications in polycystic ovarian syndrome (PCOS) women. Heart rate recovery (HRR) is an easy test for autonomic nervous tone evaluation and a powerful index for predicting cardiovascular events and mortality. Adiponectin (APN) is reported to be correlated closely with autonomic nervous function in different populations.Methods: This study aimed to investigate the relationship between serum total APN and HRR in PCOS women. A total of 89 PCOS women were enrolled and divided into two groups. Women with HRR values slower than 12 beats were defined as Blunted HRR Group. APN levels were compared between Blunted HRR Group and Normal HRR Group. Multivariate logistic regression analysis and multiple linear regression analysis were performed to determine which clinical variables were independently associated with decreased HRR and the effect of clinical variables on APNlevels, respectively. Results: 23 women were categorized in Blunted HRR Group, in which the APN level was significantly lower than Normal HRR Group (10.2±3.9 ug/ml vs. 13.1±4.1 ug/ml, P=0.015). Age [odds ratio (OR) = 1.15; 95% confidence interval (CI) = 1.04-1.21; P = 0.032], BMI (OR = 0.93; 95% CI = 0.72-1.08; P = 0.006), hypertension (OR = 1.08; 95%CI = 1.02-1.26; P = 0.025) and APN (OR= 0.61; 95%CI = 0.43-0.88; P = 0.018) were independent factors of attenuated HRR in PCOS women. Meanwhile, multiple linear regression analysis showed only age (β=-0.26; 95%CI =-0.47- -0.03, P= 0.041) and hyperlipemia (β=-0.13; 95%CI =-0.27-0.08, P= 0.024) were closely associated with APN levels in PCOS women.Conclusions: Our findings suggested that decreased APN concentration was closely associated with HRR blunt in PCOS women. Further studies are needed to explore the underlying interactions between APN and autonomic nervous function.

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Section: Introductionmentioning

confidence: 99%

Association Between Circulating Adiponectin and Heart Rate Recovery in Women With Polycystic Ovarian Syndrome

Zheng¹,

Feng

et al. 2021

Preprint

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“…The arterial baroreflex is a key homeostatic mechanism that regulates fluctuations in blood pressure that occur with each heartbeat. Women with AE-PCOS show poor baroreflex function [ 55 ]. Further, AE-PCOS is also associated with impaired cardiac (cardiovagal) baroreflex [ 56 ], which contributes to sympathovagal dysfunction during standing [ 57 ] and impaired autonomic control [ 58 ].…”

Section: Introductionmentioning

confidence: 99%

“…In general, plasma testosterone levels and peripheral, i.e., muscle sympathetic neural activity (MSNA), are positively correlated [ 59 ]. Women with AE-PCOS also demonstrate increased spontaneous MSNA [ 60 ] and resting blood pressure versus healthy controls, as well as decreased sympathetic baroreflex gain—i.e., the slope of the relationship between MSNA and blood pressure, further demonstrating impaired autonomic control of blood pressure in women with AE-PCOS [ 55 ]. It follows that elevated testosterone in women may impair sympathetic baroreflex control of arterial blood pressure.…”

Section: Introductionmentioning

confidence: 99%

Pathophysiological effects of androgens on the female vascular system

Stone

Stachenfeld

2020

Biol Sex Differ

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Sex hormones and their respective receptors affect vascular function differently in men and women, so it is reasonable to assume they play a role in the sex differences in cardiovascular disease states. This review focuses on how the effects of testosterone on arterial vessels impact the female vasculature. In women with androgen-excess polycystic ovary syndrome, and in transgender men, testosterone exposure is associated with high blood pressure, endothelial dysfunction, and dyslipidemia. These relationships suggest that androgens may exert pathophysiological effects on the female vasculature, and these effects on the female vasculature appear to be independent from other co-morbidities of cardiovascular disease. There is evidence that the engagement of androgens with androgen receptor induces detrimental outcomes in the female cardiovascular system, thereby representing a potential causative link with sex differences and cardiovascular regulation. Gender affirming hormone therapy is the primary medical intervention sought by transgender people to reduce the characteristics of their natal sex and induce those of their desired sex. Transgender men, and women with androgen-excess polycystic ovary syndrome both represent patient groups that experience chronic hyperandrogenism and thus lifelong exposure to significant medical risk. The study of testosterone effects on the female vasculature is relatively new, and a complex picture has begun to emerge. Long-term research in this area is needed for the development of more consistent models and controlled experimental designs that will provide insights into the impact of endogenous androgen concentrations, testosterone doses for hormone therapy, and specific hormone types on function of the female cardiovascular system.

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“…This has been associated with increased visceral fat and metabolic syndrome, [4][5][6][7] which predisposes to the development of metabolic chronic diseases 2,6,7 and of cardiovascular disorders that directly impair the physiology of normal heart function and are often accompanied by impairments in cardiac autonomic control. [8][9][10] It has been demonstrated that there is a cardiovascular autonomic imbalance in women with PCOS, with increased autonomic sympathetic cardiac modulation and reduced parasympathetic modulation, which increases the risk of cardiovascular disease. 3,10,11 Noninvasive, reproducible, and low-cost tests have been used to evaluate autonomic function, specifically, heart rate variability (HRV), [12][13][14][15] which can be analyzed in both a linear and in a nonlinear manner.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] It has been demonstrated that there is a cardiovascular autonomic imbalance in women with PCOS, with increased autonomic sympathetic cardiac modulation and reduced parasympathetic modulation, which increases the risk of cardiovascular disease. 3,10,11 Noninvasive, reproducible, and low-cost tests have been used to evaluate autonomic function, specifically, heart rate variability (HRV), [12][13][14][15] which can be analyzed in both a linear and in a nonlinear manner. On the other hand, the tilt test, which involves autonomic provocations by means of postural changes from supine to orthostatic positions (standing, 90°; passively or actively), allows a better evaluation of the autonomic modulation.…”

Section: Introductionmentioning

confidence: 99%

Increased Sympathetic Cardiac Autonomic Modulation after Two Consecutive Tilt Tests in Women with Polycystic Ovary Syndrome

Ribeiro

Kogure

Silva

et al. 2020

Rev Bras Ginecol Obstet

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Objective The present study aimed to analyze cardiac autonomic modulation via spectral and symbolic analysis of heart rate variability (HRV) in women with polycystic ovary syndrome (PCOS) who were subjected to two consecutive tilt tests. Methods A total of 64 women were selected and divided into 2 groups: control (without PCOS), and PCOS. Concentrations of follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, homocysteine, sex hormone-binding globulin, thyroid stimulating hormone, fasting insulin, testosterone, androstenedione, and 17-hydroxyprogesterone levels, triglycerides, free androgen index (FAI), and homeostasis assessment model (HOMA-IR) were assessed. Cardiac autonomic modulation was evaluated by spectral and symbolic analyses during two consecutive tilt tests (two moments) and supine moments before, between and after (three moments) the tilt tests. Results Women with PCOS had higher fasting insulin, HOMA-IR indexes, testosterone and FAI. Additionally, we observed that the PCOS group had greater sympathetic autonomic cardiac modulation in supine 2, tilt 1, and supine 3 moments compared with controls. Conclusion Women with PCOS had higher autonomic sympathetic cardiac modulation even after a second tilt test. No adaptation to this provocative test was observed. Spectral analysis was more sensitive for identifying differences between groups than the symbolic analysis.

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Cardiovascular autonomic dysfunction in women with polycystic ovary syndrome: a systematic review and meta-analysis

Cited by 16 publications

References 59 publications

Association Between Circulating Adiponectin and Heart Rate Recovery in Women With Polycystic Ovarian Syndrome

Association Between Circulating Adiponectin and Heart Rate Recovery in Women With Polycystic Ovarian Syndrome

Pathophysiological effects of androgens on the female vascular system

Increased Sympathetic Cardiac Autonomic Modulation after Two Consecutive Tilt Tests in Women with Polycystic Ovary Syndrome

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