Endothelial function measured using flow‐mediated dilation in polycystic ovary syndrome: a meta‐analysis of the observational studies

Sprung, Victoria S.; Atkinson, Greg; Cuthbertson, Daniel J.; Pugh, Christopher J. A.; Aziz, Nabil; Green, Daniel; Cable, N. Timothy; Jones, Helen

doi:10.1111/j.1365-2265.2012.04490.x

Cited by 112 publications

(99 citation statements)

References 49 publications

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“…This is reflected in impaired endothelial function as measured by flowmediated dilation of the brachial artery, already at an early age and confirmed by the recent meta-analysis (193). Besides the early functional impairment of the vascular wall, the morphologic signs of early atherogenesis as increased intima-media thickness of carotid arteries (C-IMT) are highly prevalent in young women with PCOS (194,195,196).…”

Section: Cardiometabolic Risk In Pcos: the Heart Of The Problemmentioning

confidence: 52%

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

568

492

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Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.

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Section: Cardiometabolic Risk In Pcos: the Heart Of The Problemmentioning

confidence: 52%

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

568

492

View full text Add to dashboard Cite

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“…147,148 A meta-analysis of several studies reported a significant decrease in flow-mediated endothelial dilation associated with PCOS after accounting for age and BMI, although there was substantial heterogeneity between studies. 149 Differences in carotid intima-media thickness and impairment in peripheral vascular function could be attributed at least in part to insulin resistance, obesity, or dyslipidemia. 144,[150][151][152][153][154][155] Although a few studies report greater CAC in women with PCOS than in those who do not have PCOS, [156][157][158][159] these data must be interpreted cautiously because of the influence of obesity on CAC measurements and the low prevalence of detectable CAC among young women (5.1% of women 33-45 years of age).…”

Section: Pcos and Surrogates For Cvdmentioning

confidence: 99%

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

et al. 2015

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Currently, ≈1 in 13 people living in the United States has DM, and 90% to 95% of these individuals have type 2 DM (T2DM).2 Overall, the prevalence of T2DM is similar in women and men. In the United States, ≈12.6 million women (10.8%) and 13 million men (11.8%) ≥20 years of age are currently estimated to have T2DM. 2 Among individuals with T2DM, cardiovascular disease (CVD) is the leading cause of morbidity and mortality and accounts for >75% of hospitalizations and >50% of all deaths.3 Although nondiabetic women have fewer cardiovascular events than nondiabetic men of the same age, this advantage appears to be lost in the context of T2DM. 4,5 The reasons for this advantage are not entirely clear but are likely multifactorial with contributions from inherent physiological differences, including the impact of the sex hormones, differences in cardiovascular risk factors, and differences between the sexes in the diagnosis and treatment of DM and CVD. 6 In addition, there are racial and ethnic factors to consider because women of ethnic minority backgrounds have a higher prevalence of DM than non-Hispanic white (NHW) women.This scientific statement was designed to provide the current state of knowledge about sex differences in the cardiovascular consequences of DM, and it will identify areas that would benefit from further research because much is still unknown about sex differences in DM and CVD. Areas that are discussed include hormonal differences between the sexes and their possible effects on the interaction between DM and CVD, sex differences in epidemiology, ethnic and racial differences and risk factors for CVD in DM across the life span, sex differences in various types of CVD and heart failure, and sex differences in the effects of treatments for DM, including both medications and lifestyle. In addition, there is discussion about risk factors that are specific to women, including gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS), which affect CVD risk. Table 1 focuses on sex differences in CVD risk factors and outcomes in DM, and Table 2 provides information about sex differences in CVD treatments and interventions in DM. Table 3 contains some of the important ideas for research in sex differences in the cardiovascular consequences of DM. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 31, 2015, and the American Heart Association Executive Committee on September 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By...

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“…The risk of publication or other biases was detected when assessing the SMD in endothelial function. However, the quality of studies was evaluated by specific tools for the quality assessment of observational research, 81,82 revealing a predominantly low-bias risk. It must be acknowledged that the ethnicity of the populations was poorly reported by studies included in this meta-analysis, and thus, conclusions on the effect of ethnicity cannot be drawn from these data.…”

mentioning

confidence: 99%

Acute Hyperglycemia Impairs Vascular Function in Healthy and Cardiometabolic Diseased Subjects

Loader

Montero

Lorenzen

et al. 2015

ATVB

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Objectives-Controversy exists over the effect of acute hyperglycemia on vascular function. In this systematic review, we compared the effect of acute hyperglycemia on endothelial and vascular smooth muscle functions across healthy and cardiometabolic diseased subjects. Approach and Results-A systematic search of MEDLINE, EMBASE, and Web of Science from inception until July 2014 identified articles evaluating endothelial or vascular smooth muscle function during acute hyperglycemia and normoglycemia. Meta-analyses compared the standardized mean difference (SMD) in endothelial and vascular smooth muscle functions between acute hyperglycemia and normoglycemia. Subgroup analyses and metaregression identified sources of heterogeneity. Thirty-nine articles (525 healthy and 540 cardiometabolic subjects) were analyzed. Endothelial function was decreased (39 studies; n=1065; SMD, −1.25; 95% confidence interval, −1.52 to −0.98; P<0.01), whereas vascular smooth muscle function was preserved (6 studies; n=144; SMD, −0.07; 95% confidence interval, −0.30 to 0.16; P=0.55) during acute hyperglycemia compared with normoglycemia. Significant heterogeneity was detected among endothelial function studies (P<0.01). A subgroup analysis revealed that endothelial function was decreased in the macrocirculation (30 studies; n=884; SMD, −1.40; 95% confidence interval, −1.68 to −1.12; P<0.01) but not in the microcirculation (9 studies; n=181; SMD, −0.63; 95% confidence interval, −1.36 to 0.11; P=0.09). Similar results were observed according to health status. Macrovascular endothelial function was inversely associated with age, blood pressure, and low-density lipoprotein cholesterol and was positively associated with the postocclusion interval of vascular assessment. Conclusions-To our knowledge, this is the first systematic review and meta-analysis of its kind. In healthy and diseased subjects, we found evidence for macrovascular but not microvascular endothelial dysfunction during acute hyperglycemia. Loader et al Acute Hyperglycemia Impairs Vascular Function 2061in vitro studies suggest that acute hyperglycemia may also impair VSM function by disrupting VSM cell apoptosis, causing subsequent VSM cell proliferation and desensitization to NO. [19][20][21] However, whether endothelial and VSM functions are transiently impaired during acute hyperglycemia in humans is unclear because of discrepant results. Given this, we conducted a systematic review and meta-analysis of available studies comparing endothelial function alone or in combination with VSM function during acute hyperglycemia in healthy and cardiometabolic diseased individuals. To our knowledge, this represents the first systematic review and meta-analysis to assess the effect of acute hyperglycemia on vascular function. Materials and MethodsMaterials and methods are available in the online-only Data Supplement. Results Study Selection and CharacteristicsA flowchart of study selection is shown in Figure 1. The systematic search resulted in the inclusion of 39 from 394 potential a...

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Endothelial function measured using flow‐mediated dilation in polycystic ovary syndrome: a meta‐analysis of the observational studies

Abstract: This systematic research synthesis indicates that endothelial function is compromised in PCOS women, even if they are young and nonobese.

Cited by 112 publications

References 49 publications

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

Acute Hyperglycemia Impairs Vascular Function in Healthy and Cardiometabolic Diseased Subjects

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