Metformin improves endothelial function and carotid intima media thickness in patients with PCOS

Kaya, Mehmet; Yıldırım, Sümeyra; Çalapkorur, Bekir; Akpek, Mahmut; Ünlühızarcı, Kürşad; Keleştimur, Fahrettin

doi:10.3109/09513590.2015.1006188

Cited by 27 publications

(15 citation statements)

References 27 publications

(25 reference statements)

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“…63 Treatment with oral contraceptives worsened cIMT in women in their 20s with PCOS, whereas combination therapy with oral contraceptives and metformin decreased cIMT. 64 More recently, it has been demonstrated that a 6-month structured exercise program results in a reduction of cIMT, whereas those on oral contraceptives had no change in measurements. 65 Based on these studies, impacts of PCOS therapies on cIMT and other markers of CVD risk need to be considered in order to reduce the development of CVD.…”

Section: Discussionmentioning

confidence: 99%

Obese adolescents with polycystic ovarian syndrome have elevated cardiovascular disease risk markers

et al. 2017

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Women with polycystic ovarian syndrome (PCOS) have evidence of subclinical cardiovascular disease (CVD). However, insulin resistance, an important factor in the development of CVD in adults, is common in adolescents with PCOS, yet data in adolescents are limited. Therefore, we sought to measure insulin resistance and CVD markers in obese youth with and without PCOS. Thirty-six PCOS and 17 non-PCOS adolescent girls who were obese, sedentary, and non-hypertensive were recruited from clinics located within the Children's Hospital Colorado. Following 3 days of controlled diet and restricted exercise, fasting plasma samples were obtained prior to a hyperinsulinemic euglycemic clamp. PCOS girls were more insulin resistant than controls (glucose infusion rate 5.24±1.86 mg/kg/min vs 9.10±2.69; p<0.001). Girls with PCOS had blood pressure in the normal range, but had greater carotid intima–media thickness (cIMT) (0.49±0.07 mm vs 0.44±0.06; p=0.038), beta stiffness index (5.1±1.3 U vs 4.4±0.9; p=0.037), and reduced arterial compliance (1.95±0.47 mm2/mmHg × 10−1 vs 2.13±0.43; p=0.047). PCOS girls had a normal mean lipid profile, yet had a more atherogenic lipoprotein cholesterol distribution and had persistent elevations of free fatty acids despite hyperinsulinemia (68±28 μmol/mL vs 41±10; p=0.001), both potential contributors to CVD. Free fatty acid concentrations correlated best with all CVD markers. In summary, adolescent girls with PCOS have greater cIMT and stiffer arteries than girls without PCOS, perhaps related to altered lipid metabolism, even when clinical measures of blood pressure and cholesterol profiles are ‘normal’. Therefore, management of adolescent PCOS should include assessment of CVD risk factor development.

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Section: Discussionmentioning

confidence: 99%

Obese adolescents with polycystic ovarian syndrome have elevated cardiovascular disease risk markers

et al. 2017

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“… 42 Women with PCOS are also at an increased risk of CVD owing to the hyperinsulinemia, high androgen levels, obesity and dyslipidaemia. 43 There is evidence that obesity and PCOS independently affect vascular endothelial function 44 ; however, the association between high insulin levels and CVD is independent of obesity. 45 , 46 Women with PCOS have worse lipid profiles compared with the healthy population and they typically have low high-density lipoprotein (HDL) and high triglyceride levels that are both strong predictors of CVD.…”

Section: Treatment Options For Managing Metabolic Comorbiditiesmentioning

confidence: 99%

A review of therapeutic options for managing the metabolic aspects of polycystic ovary syndrome

Abdalla

Deshmukh

Atkin

et al. 2020

Therapeutic Advances in Endocrinology

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Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Metabolic sequelae associated with PCOS range from insulin resistance to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Insulin resistance plays a significant role in the pathophysiology of PCOS and it is a reliable marker for cardiometabolic risk. Although insulin sensitising agents such as metformin have been traditionally used for managing metabolic aspects of PCOS, their efficacy is low in terms of weight reduction and cardiovascular risk reduction compared with newer agents such as incretin mimetics and SGLT2 inhibitors. With current pharmaceutical advances, potential therapeutic options have increased, giving patients and clinicians more choices. Incretin mimetics are a promising therapy with a unique metabolic target that could be used widely in the management of PCOS. Likewise, bariatric procedures have become less invasive and result in effective weight loss and the reversal of metabolic morbidities in some patients. Therefore, surgical treatment targeting weight loss becomes increasingly common in the management of obese women with PCOS. Newer emerging therapies, including twincretins, triple GLP-1 agonists, glucagon receptor antagonists and imeglemin, are promising therapeutic options for treating T2DM. Given the similarity of metabolic and pathological features between PCOS and T2DM and the variety of therapeutic options, there is the potential to widen our strategy for treating metabolic disorders in PCOS in parallel with current therapeutic advances. The review was conducted in line with the recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.

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“…Metformin treatment is also associated with a decrease in HOMA-IR. Metformin treatment for 3 months improves arterial stiffness and associated endothelial dysfunction as well as reducing carotid intima media thickness in women with PCOS (Agarwal, et al, 2010;Kaya, et al, 2015). There are several clinical trials (https://clinicaltrials.gov) addressing the effects of metformin alone (NCT00169624) or in combination with other anti-diabetic drugs in patients with Type 2 diabetes (NCT00169624) and PCOS (NCT01459445).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Endothelial function and dysfunction: Impact of metformin

Nafisa

Gray

Cao

et al. 2018

Pharmacology & Therapeutics

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Cardiovascular and metabolic diseases remain the leading cause of morbidity and mortality worldwide. Endothelial dysfunction is a key player in the initiation and progression of cardiovascular and metabolic diseases. Current evidence suggests that the anti-diabetic drug metformin improves insulin resistance and protects against endothelial dysfunction in the vasculature. Hereby, we provide a timely review on the protective effects and molecular mechanisms of metformin in preventing endothelial dysfunction and cardiovascular and metabolic diseases.

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Metformin improves endothelial function and carotid intima media thickness in patients with PCOS

Abstract: We demonstrated that adding metformin to OCP treatment may have beneficial effect on FMD and CIMT that represent vascular function in patients with PCOS. These results suggest that adding metformin to OCP treatment for PCOS could preserve the cardiovascular system and improve it.

Cited by 27 publications

References 27 publications

Obese adolescents with polycystic ovarian syndrome have elevated cardiovascular disease risk markers

Obese adolescents with polycystic ovarian syndrome have elevated cardiovascular disease risk markers

A review of therapeutic options for managing the metabolic aspects of polycystic ovary syndrome

Endothelial function and dysfunction: Impact of metformin

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