Pharmacological Approaches to Controlling Cardiometabolic Risk in Women with PCOS

Abstract

Polycystic ovary syndrome (PCOS) is characterized by elevated androgen production and subclinical changes in cardiovascular and metabolic risk markers. Total cholesterol, high-density lipoprotein (HDL) cholesterol, fasting glucose, and fasting insulin appear to increase specifically in PCOS compared with fertile women. PCOS also confers an increased risk of cardiometabolic disease in later life. Novel biomarkers such as serum’s cholesterol efflux capacity and blood-derived macrophage activation profile may assist in more accurately defining the cardiometabolic risk profile in these women. Aldosterone antagonists, androgen receptor antagonists, 5α-reductase inhibitors, and synthetic progestogens are used to reduce hyperandrogenism. Because increased insulin secretion enhances ovarian androgen production, short-term treatment with metformin and other hypoglycemic agents results in significant weight loss, favorable metabolic changes, and testosterone reduction. The naturally occurring inositols display insulin-sensitizing effects and may be also used in this context because of their safety profile. Combined oral contraceptives represent the drug of choice for correction of androgen-related symptoms. Overall, PCOS management remains focused on specific targets including assessment and treatment of cardiometabolic risk, according to disease phenotypes. While new options are adding to established therapeutic approaches, a sometimes difficult balance between efficacy and safety of available medications has to be found in individual women.

Evaluation of the cardiovascular risk in women with PCOS

“…Polycystic ovary syndrome (PCOS) is a widespread endocrine and metabolic disorder which affects both adult and adulthood women (1) and is associated with menstrual irregularity, hyperandrogenism, and infertility among women of childbearing period (2). PCOS in adolescents is associated with adiposity, higher androgen concentrations and greater menstrual irregularity, in youth PCOS is considered a risk factor for type 2 diabetes mellitus in adulthood (3) and confers an increased risk of cardiometabolic disease in later life (4).…”

The Role of Oxidative Stress in the Risk of Cardiovascular Disease and Identification of Risk Factors Using AIP and Castelli Atherogenicity Indicators in Patients with PCOS

“…Nearly 50% of PCOS women progress to metabolic syndrome (MetS). MetS refers to a group of conditions, including dyslipidemia, impaired glucose tolerance, hypertension, central adiposity, and cardiovascular disease (CVD) [ 5 , 6 , 7 ]. All of these conditions can cause coronary heart disease and diabetes [ 8 , 9 ].…”

Sodium-glucose cotransporter-2 inhibitors for improving endocrine and metabolic profiles in overweight and obese individuals with polycystic ovary syndrome: a meta-analysis protocol

“…Polycystic ovary syndrome (PCOS) is a heterogeneous reproductive endocrine disorder associated with oligomenorrhoea or amenorrhoea, hyperandrogenaemia and polycystic ovaries, according to the Rotterdam criteria 1 2. Approximately 30%–60% of patients with PCOS are overweight or obese, and 95% of them have insulin resistance (IR) 3 4.…”

“…Alleviating IR is an appealing target for PCOS treatment, and several insulin-sensitisers have been developed to control PCOS 2. Metformin is the most common oral insulin sensitiser for patients with PCOS, which reduces hyperinsulinaemia and hyperandrogenaemia 11.…”