Effect of Lifestyle Modification and Metformin Therapy on Emerging Cardiovascular Risk Factors in Overweight Indian Women with Polycystic Ovary Syndrome

Rajagopal, G; Reddy, Amaresh P; Harinarayan, CV; Suresh, V; Bitla, Aparna R.; Rao, Srinivasa; Sachan, Alok

doi:10.1089/met.2011.0127

Cited by 8 publications

(11 citation statements)

References 55 publications

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“…The increase of serum Hcy concentration in the metformin-treated patients was confirmed by a series of observational studies [16][17][18]20,25,[52][53][54][55][56]. These studies indicated that metformin was associated with an elevated concentration of serum Hcy compared with control treatment.…”

Section: Discussionmentioning

confidence: 80%

Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhang

et al. 2016

Value in Health

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Abstract:The aim of this systematic review is to assess whether metformin could change the concentration of serum homocysteine (Hcy) with and without simultaneous supplementation of B-group vitamins or folic acid. A literature search was conducted in PubMed, EmBase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) reporting the concentration of serum Hcy in metformin-treated adults. Meta-analysis was applied to assess the association between metformin and the changes of Hcy concentration. Twelve publications were included in this study. In the overall analysis, metformin administration was not statistically associated with the change of Hcy when compared with the control treatment (mean difference (MD), 0.40 µmol/L; 95% confidence interval (CI), −0.07~0.87 µmol/L, p = 0.10). In the subgroup analysis, metformin was significantly associated with an increased concentration of Hcy in the absence of exogenous supplementation of folic acid or B-group vitamins (MD, 2.02 µmol/L; 95% CI, 1.37~2.67 µmol/L, p < 0.00001), but with a decreased concentration of serum Hcy in the presence of these exogenous supplementations (MD, −0.74 µmol/L; 95% CI, −1.19~−0.30 µmol/L, p = 0.001). Therefore, although the overall effect of metformin on the concentration of serum Hcy was neutral, our results suggested that metformin could increase the concentration of Hcy when exogenous B-group vitamins or folic acid supplementation was not given.

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Section: Discussionmentioning

confidence: 80%

Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhang

et al. 2016

Value in Health

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“…This meta-analysis finally included 41 eligible studies, of which 34 [ 7 , 11 – 43 ] were in quantitative synthesis for homocysteine levels in PCOS, and seven [ 21 , 22 , 52 – 56 ] covered homocysteine levels in PCOS patients treated with metformin. Fig 1 shows the search flow diagram; in addition, the excluded articles with reasons for exclusion were shown in S1 File .…”

Section: Resultsmentioning

confidence: 99%

Association between High Serum Homocysteine Levels and Biochemical Characteristics in Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis

et al. 2016

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BackgroundElevated homocysteine levels have been observed in previous studies of PCOS; however, the nature of the associations between high homocysteine levels and the biochemical characteristics of polycystic ovarian syndrome (PCOS)—such as obesity, insulin resistance (IR), and androgen levels—is still uncertain.MethodsA systematic search was conducted electronically up to December 28, 2015 using specific eligibility criteria. Standardized mean difference (SMD) and the corresponding 95% confidence intervals (95% CIs) were used as a measure of effect size.ResultsA total of 34 studies (with 1,718 cases and 1,399 controls) of homocysteine levels in PCOS were pooled in this meta-analysis. Significantly lower homocysteine levels were found in controls than in PCOS patients (SMD = 0.895, 95% CI = 0.643–1.146, P<0.001; I2 = 90.4% and P<0.001 for heterogeneity), regardless of the degree of obesity, IR, or androgen levels. Homocysteine levels in non-IR PCOS patients were significantly lower than those of PCOS patients with IR (SMD = 0.69, 95% CI = 0.37–1.01, P<0.01; I2 = 0% and P = 0.50 for heterogeneity). However, metformin treatment did not appear to cause any significant change in the homocysteine levels of PCOS patients (SMD = –0.17, 95% CI = –1.10–0.75, P = 0.71; I2 = 92% and P<0.01 for heterogeneity).ConclusionsHigh homocysteine levels in women with PCOS are not related to degree of obesity, IR, or androgen levels. Metformin treatment cannot decrease the homocysteine levels in PCOS patients.

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“…Studies on non-pharmacological measures to treat PCOS are very limited in the Indian literature. In a study on reproductive-age women with PCOS, improvement in novel inflammatory cardiac risk markers such as hs-CRP was reported with lifestyle modification, although metformin was also given to the study participants79.…”

Section: Management Of Pcosmentioning

confidence: 99%

Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India

et al. 2019

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Polycystic ovary syndrome (PCOS) is a common endocrine disorder predominantly affecting women of reproductive age. Clinical manifestations are diverse including hyperandrogenism, anovulation, infertility and increased risk of metabolic diseases besides psychosocial dysfunction. This review provides information on the problem of PCOS in India, its pathophysiology, genetics and an overview of current management options to instigate further research in this field. Prevalence of PCOS in India ranges from 3.7 to 22.5 per cent depending on the population studied and the criteria used for diagnosis. Abnormalities in leptin-adiponectin (adipocyte biology), oxidative stress and autoimmunity are among the mechanisms studied regarding pathogenesis of PCOS. Many candidate gene studies have shown associations with PCOS in various studies. Studies have consistently demonstrated the relationship between the well-known manifestation of hyperandrogenism among Indian PCOS women and the metabolic morbidities including insulin resistance, glucose intolerance and cardiovascular risk. Management of individual components of PCOS can be achieved by medications or surgical methods, though further clarification regarding pathogenesis of PCOS is needed to sharpen our therapeutic armamentarium.

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Effect of Lifestyle Modification and Metformin Therapy on Emerging Cardiovascular Risk Factors in Overweight Indian Women with Polycystic Ovary Syndrome

Cited by 8 publications

References 55 publications

Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Association between High Serum Homocysteine Levels and Biochemical Characteristics in Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis

Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India

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