Low Grade Chronic Inflammation in Women with Polycystic Ovarian Syndrome

Abstract

Low grade chronic inflammation as reflected by increased C-reactive protein (CRP) concentrations independently predicts those at risk for coronary heart disease (CHD) and type 2 diabetes. Women with polycystic ovarian syndrome (PCOS) are insulin resistant and have increased risk for CHD and type 2 diabetes, but currently there are no data on markers of inflammation in women with PCOS. Seventeen women with PCOS (defined on the basis of elevated testosterone and oligomenorrhea) and 15 healthy women matched as a group for body mass index were recruited. Measurement of CRP concentrations was made using a highly sensitive assay. Insulin resistance was assessed using the hyperinsulinemic euglycemic clamp technique. The women with PCOS had significantly elevated CRP concentrations relative to controls (geometric means, 2.12 and 0.67 mg/L, respectively; P = 0.016). Log CRP correlated with body mass index in both PCOS and controls (r = 0.58; P < 0.05 and r = 0.78; P < 0.01, respectively) and inversely with insulin sensitivity (r = -0.57; P < 0.05 and r = -0.69; P < 0.01). Total testosterone did not correlate with log CRP in either group. On adjustment for body mass index and age, there remained a significant difference in log CRP between PCOS and controls (t = 2.13; P < 0.05). On further adjustment for insulin sensitivity, log CRP was no longer significantly different between groups (t = 1.51; P = 0.14). We conclude that women with PCOS have significantly increased CRP concentrations relative to women with normal menstrual rhythm and normal androgen levels. We propose low grade chronic inflammation as a novel mechanism contributing to increased risk of CHD and type 2 diabetes in these women.

Obesity, and not insulin resistance, is the major determinant of serum inflammatory cardiovascular risk markers in pre-menopausal women

“…On the contrary, we have not found the increased CRP concentrations recently reported in a smaller series of PCOS patients and healthy controls from Scotland [40]. Nevertheless, we have shown that hyperandrogenism is influenced by certain TNF-α, TNFR2 and IL-6 genotypes [14,15,16], supporting that low grade chronic inflammation might influence the pathogenesis of PCOS.…”

Serum osteoprotegerin concentrations are decreased in women with the polycystic ovary syndrome

“…Over past years, a chronic proinflammatory state has been associated with hyperandrogenism and PCOS (2). On the one hand, increased serum C-reactive protein concentrations have been reported in PCOS patients (3). On the other hand, we have shown that common polymorphisms in the genes encoding tumour necrosis factor (TNF)-a, type 2 TNF receptor, interleukin (IL)-6, and the IL-6 signaling molecule gp130 are associated with hyperandrogenism and PCOS, or influence hyperandrogenic phenotypic traits (4)(5)(6)(7).…”

C-reactive protein level and obesity as cardiovascular risk factors in polycystic ovary syndrome

“…CRP veya IL-6 gibi düşük doz kronik inflamasyonu gösteren belirteçlerin Tip II DM gelişiminin önemli prediktörleri olduğu gösterilmiştir. Bazı çalışmalarda PKOS'lu hastalarda CRP düzeyleri yüksek olarak bulunmuş, bu da PKOS' ta DM riski artışının kronik inflamasyonun tetiklemesi sonucu olabileceği şeklinde yorumlanmıştır [22]. Artmış serum CRP konsantrasyonları, PKOS' ta da sıklıkla görülen obezite ve insulin rezistansı ile de ilişkili bulunmuştur [23,24,25].…”