Obesity and insulin resistance but not hyperandrogenism mediates vascular dysfunction in women with polycystic ovary syndrome

Dokras, Anuja; Jagasia, Dinesh; Maifeld, Michelle; Sinkey, Christine A.; Voorhis, Bradley J. Van; Haynes, William G.

doi:10.1016/j.fertnstert.2006.05.038

Cited by 44 publications

(44 citation statements)

References 40 publications

(51 reference statements)

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“…In PCOS, the association of androgens with peripheral vascular dysfunction is variable. In 2 studies, there was no association, 151,188 whereas other studies reported significant associations of testosterone with endothelial dysfunction. 153,154,189 In contrast, an inverse association of the adrenal androgen dehydroepiandrosterone sulfate has been seen with carotid intimamedia thickness in PCOS.…”

Section: The Influence Of Sex Hormones On Cardiovascular Risk In Pcosmentioning

confidence: 94%

“…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). 160 In obesity, x-ray scatter from adjacent soft tissue increases the false-positive rate, with duplicate scans in obese individuals demonstrating the highest rate of false positives with CAC scores <10.…”

Section: Pcos and Surrogates For Cvdmentioning

confidence: 99%

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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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Section: The Influence Of Sex Hormones On Cardiovascular Risk In Pcosmentioning

confidence: 94%

Section: Pcos and Surrogates For Cvdmentioning

confidence: 99%

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

et al. 2015

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“…However, 6-month metformin treatment was shown to retain efficacy in ameliorating endothelial dysfunction in lean normoinsulinemic women with PCOS (153). This finding suggests that other mechanisms, apart from IR, contribute to the endothelial effects of this drug.…”

Section: Other Cardiovascular Risk Factors and Markersmentioning

confidence: 95%

Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome

Diamanti-Kandarakis

Christakou

Kandaraki

et al. 2010

European Journal of Endocrinology

206

184

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Polycystic ovary syndrome (PCOS) is now recognized to be the most common endocrinopathy in women of reproductive age with a prevalence of 6.6-6.8%. PCOS, a syndrome of unknown etiology, was initially regarded as a reproductive disorder. However, in the last 15 years the role of insulin resistance (IR) has been identified as a significant contributor to the pathogenesis of PCOS, and the metabolic and cardiovascular sequelae of the syndrome have been increasingly appreciated. The coexistence and interaction of reproductive and cardiometabolic abnormalities in the context of PCOS have created a need for a modified therapeutic management of affected women. Insulin sensitizers, particularly metformin, have been introduced as a pharmaceutical option targeting not only IR, but several other aspects of the syndrome, including reproductive abnormalities. The landscape of the multifaceted actions of metformin evolves to broaden the therapeutic implications of this old drug in a new fashion for patients with PCOS. Most recently, the spectrum of metformin's targets has been expanded, and molecular studies have explored the tissue-specific mechanisms of metformin in the liver, the muscle, the endothelium, and the ovary. The use of metformin in pregnant women with PCOS comprises another scarcely explored, but promising area of research. This review attempts to cover the spectrum of metformin's cellular actions in different tissues and to summarize the current literature regarding the potential medical value of this medication in PCOS. Even if many of these actions are individually modest, they seem to be collectively sufficient to confer therapeutic benefits not only in cardiometabolic aspects but also in reproductive aspects of PCOS.

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“…Specifically, both obesity and insulin resistance predispose women with PCOS to endothelial dysfunction [44][45][46] , and obese, insulin-resistant women with PCOS have metabolic profiles consistent with dyslipidemia 47,48 . Obesity and insulin resistance also represent independent risk factors for the metabolic syndrome, which will be discussed below.…”

Section: Consequences Of Obesity and Insulin Resistancementioning

confidence: 99%

Statins in the Treatment of Polycystic Ovary Syndrome

Kodaman

Dulęba²

2008

Semin Reprod Med

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Many women of reproductive age are affected by polycystic ovary syndrome (PCOS), a heterogeneous endocrinopathy characterized by androgen excess, chronic oligo-anovulation and/or polycystic ovarian morphology. In addition, PCOS is often associated with insulin resistance, systemic inflammation and oxidative stress which, on one hand, lead to endothelial dysfunction and dyslipidemia with subsequent cardiovascular sequelae and, on the other hand, to hyperplasia of the ovarian theca compartment with resultant hyperandrogenism and anovulation. While traditionally statins have been used to treat dyslipidemia by blocking HMG-CoA reductase, the rate limiting step in cholesterol biosynthesis; in fact, they possess pleiotropic actions, resulting in antioxidant, antiinflammatory and anti-proliferative effects. Statins offer a novel therapeutic approach to PCOS in that they address the dyslipidemia associated with the syndrome, as well as hyperandrogenism/ hyperandrogenemia. These actions may be due to an inhibition of the effects of systemic inflammation and insulin resistance/hyperinsulinemia. Evidence to date, both in vitro and in vivo, suggests that statins have potential in the treatment of PCOS; however, further clinical trials are needed before they can be considered a standard of care in the medical management of this common endocrinopathy.

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Obesity and insulin resistance but not hyperandrogenism mediates vascular dysfunction in women with polycystic ovary syndrome

Cited by 44 publications

References 40 publications

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome

Statins in the Treatment of Polycystic Ovary Syndrome

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