Internal carotid artery haemodynamics in women with polycystic ovaries

Abstract

Although polycystic ovarian syndrome (PCOS) is associated with risk factors for cerebrovascular disease, the available evidence does not demonstrate increased stroke mortality, and it has been suggested that some protective mechanisms must be operating in these women. Haemodynamic changes have been demonstrated in the pelvic vessels and aorta in this syndrome, but there have been no studies of the cerebral circulation. Since insulin resistance is a central feature of PCOS, it is of interest that cerebral blood flow may be altered in diabetic subjects. The present study was designed to assess internal carotid artery haemodynamics in women with PCOS, asymptomatic women with polycystic ovaries (PCO women) and healthy controls. Mean internal carotid pulsatility index, measured using pulsed Doppler ultrasound under standardized conditions, was significantly lower in 35 PCOS and 15 PCO women than in the 18 controls. This was also shown on multiple regression analyses. Peak systolic velocity did not differ between groups. In view of the difficulty of interpreting pulsatility index in low-impedance vascular beds, the 'back' pressure was calculated and found to be lower in women with polycystic ovaries. This is the first demonstration of lower pulsatility index and back pressure (suggestive of reduced vascular tone) in the cerebral circulation of these women, independent of blood pressure, insulin resistance and other endocrine or metabolic factors. Changes in internal carotid haemodynamics may offset the risk of cerebrovascular disease commonly associated with polycystic ovaries.

Doppler Sonographic Evaluation of Cerebral Blood Flow in Anemia Resulting From Chronic Renal Failure

“…Measurements of the VA and ICA at the right and left sides have been reported in healthy adults and in various diseases. [7][8][9][10][11]25,26 In healthy individuals, the left VA was shown to be the dominant side, contrary to the right VA, which is compatible with our control group findings. Jeng and Yip, 27 who studied 447 subjects, found significant asymmetries in diameter, flow velocities, and blood flow with left-sided dominance; Seidel et al 24 showed nonsignificant left side dominance for VAs in 50 patients with nonvascular neurologic conditions; and Hong et al 28 found left VA dominance in their report about the reference values for the blood flow of the VA using color Doppler sonography in the 35 healthy Korean adults.…”

Reduced Estradiol-Induced Vasodilation and Poly-(ADP-Ribose) Polymerase (PARP) Activity in the Aortas of Rats with Experimental Polycystic Ovary Syndrome (PCOS)

“…In women with PCOS significant pharmacological reactivity changes develop as well as mechanical damages of the large blood vessels [3], [4]. The changes in smooth muscle and endothelium related relaxation, as well as vasoconstriction, were studied in PCOS and in hyperandrogenic circumstances.…”

“…Indeed, haemodynamic changes of internal carotid artery [4] and early predictors of endothelium dysfunction in women with PCOS were detected, as FMD (flow mediated dilatation) and nitrate-mediated dilation were significantly lower in women with PCOS than in the control group [5]. Moreover, a recent meta-analysis found a two-fold risk of coronary heart disease and stroke for patients with PCOS compared to women without PCOS [6].…”

Ocular blood flow in polycystic ovary syndrome

“…did not find any significant changes in blood flow rates, PI and back pressure of the middle cerebral artery (MCA) and internal carotid artery (ICA) in PCOS; however, Lakhani et al . have shown reduced PI and back pressure in the ICA of patients with PCOS . To our knowledge, there is no study analyzing OBF parameters in PCOS patients in the current PubMed‐based literature.…”

“…[10][11][12][13] Estimated mechanisms for this increased risk are cholesterol metabolism imbalance, insulin resistance and androgen excess. 14 15,16 To our knowledge, there is no study analyzing OBF parameters in PCOS patients in the current PubMedbased literature. The eye receives its blood supply from the OA by way of the CRA, short and long posterior ciliary arteries and the anterior ciliary arteries.…”