Incidence of prediabetes and risk of developing cardiovascular disease in women with polycystic ovary syndrome

Abstract

Our aim was to determine the incidence of prediabetes and risk of developing cardiovascular disease (CVD) in women with polycystic ovary syndrome (PCOS). This prospective, observational study included 148 women with PCOS, without Type 2 diabetes mellitus (T2DM) and CVD present at baseline. In the fasting blood samples, we measured lipids, glucose, and insulin levels during oral glucose tolerance test, levels of C-reactive protein (CRP), steroids, 25-hydroxyvitamin D (25-OHD), prolactin, thyroid-stimulating hormone, and parathyroid hormone. The follow-up period was 3 years. At baseline, prevalent prediabetes was present in 18 (12%) of PCOS cases and it progressed to T2DM in 5 (3%) of the cases. Incident prediabetes during the follow-up was noted in 47 (32%) women or 4.7 per 1000 persons/year. Prediabetes was associated with elevated body mass index (BMI) (odds ratio [OR] = 1.089, confidence interval [CI]: 1.010; 1.174, p = 0.026), high baseline levels of CRP (OR = 3.286, CI: 1.299; 8.312, p = 0.012), homeostatic model assessment - insulin resistance (IR) (OR = 2.628, CI: 1.535; 4.498, p < 0.001), and high lipid accumulation product (LAP) (OR = 1.009, CI: 1.003; 1.016, p = 0.005). Furthermore, prediabetes was associated with low 25-OHD (OR = 0.795, CI: 0.724; 0.880, p ≤ 0.05). In addition, cardiovascular risk in PCOS women with prediabetes was high (hazard ratio = 1.092, CI: 1.036; 1.128, p < 0.001). We showed association of prediabetes with high BMI, IR, markers of inflammation, LAP, and low serum 25-OHD concentration. IR appears to be more relevant than the other predictors of prediabetes risk in this study. PCOS women are considered as a high-risk population for prediabetes.

Anthropometric and central obesity indices as predictors of long-term cardiometabolic risk among Saudi young and middle-aged men and women

“…Additionally, Hosseinpanah et al36 concluded that LAP was an independent predictor of cardiovascular disease among individuals with normal BMI. Conversely, BMI, high C-reactive protein, and insulin resistance were better than LAP for the prediction of prediabetic status and cardiovascular risk in women with polycystic ovary syndrome 37. The paradox in this study was the low agreement (measured by Kappa coefficient) and high predictability (measured by area under the ROC) between the selected obesity indices and long-term CVD risk scores.…”

Polycystic ovary syndrome and the risk of cardiometabolic complications in longitudinal studies

“…The conversion rate to T2DM in PCOS women with IGT fluctuated between 2% per annum in an American study and 8.7% in Australian research, whereas Ehrmann et al described it as accelerated “perhaps as much as 5‐fold to 10‐fold” . Furthermore, Norman et al showed that 54% of PCOS women with IGT developed T2DM during 6 years, whereas in the study of Velija‐Asimi et al, 27% of patients with prediabetes progressed to T2DM after about 3 years . Legro et al demonstrated that the odds of converting from baseline NGT to IGT or T2DM were 2.4 times higher in PCOS than in controls, but the statistical significance was not achieved .…”

“…7% in Australian research,101 whereas Ehrmann et al described it as accelerated "perhaps as much as 5-fold to 10-fold" 66. Furthermore, Norman et al showed that 54% of PCOS women with IGT developed T2DM during 6 years,101 whereas in the study of Velija-Asimi et al, 27% of patients with prediabetes progressed to T2DM after about 3 years 102. Legro et al demonstrated that the odds of converting from baseline NGT…”

“…Certain authors based on patients' self-reports or databases. In 14 studies, OGTT was performed: IGT and T2DM were defined according to ADA criteria in 7 of them65,67,73,89,94,98,102 and according to WHO criteria 123 in 5,68,69,76,101,103 and both of these criteria were applied in 2 studies 66,72. Other researchers used fasting plasma glucose, HbA1c, or doctor diagnosis/antidiabetic treatment/clinical letters on the database/earliest abnormal blood test in hospital laboratory system as diagnostic criteria of T2DM.…”

“…It is well documented that making diagnosis of T2DM on the basis of the fasting glucose underestimates prevalence of T2DM 44,124. Different definitions of the MetS were used by researchers, but ATP III criteria were chosen most frequently 65,71,76,77,102,109. A further discrepancy is created by different methods of taking patients' measurements.…”