Raised plasminogen activator inhibitor‐1 (PAI‐1) is not an independent risk factor in the polycystic ovary syndrome (PCOS)

Atiomo, William; Fox, Robert; Condon, J. E.; Shaw, Steve; Friend, John; Prentice, A. G.; Wilkin, Terry

doi:10.1046/j.1365-2265.2000.00946.x

Cited by 62 publications

(33 citation statements)

References 16 publications

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“…14 While some studies have found PCOS to be associated with coronary heart disease risk factors, [15][16][17][18][19][20] other studies have shown that women with PCOS were 3 times more likely to have a family history of venous thrombosis. 21 Mak and Dokras 22 hypothesized that women with PCOS likely have an increased baseline risk for developing thrombosis compared with other women in the general population. However, no study has evaluated the prevalence of VTE among women with PCOS compared with women without PCOS.…”

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003–2008

Okoroh

Hooper

Atrash

et al. 2012

American Journal of Obstetrics and Gynecology

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OBJECTIVE-We sought to determine prevalence and likelihood of venous thromboembolism (VTE) among women with and without polycystic ovary syndrome (PCOS). STUDY DESIGN-We performed a cross-sectional analysis using Thomson Reuters MarketScanCommercial databases for the years 2003 through 2008. The association between VTE and PCOS among women aged 18-45 years was assessed using age-stratified multivariable logistic regression models.RESULTS-Prevalence of VTE per 100,000 was 374.2 for PCOS women and 193.8 for women without PCOS. Compared with women without PCOS, those with PCOS were more likely to have VTE (adjusted odds ratio [aOR] 18-24 years, 3.26; 95% confidence interval [CI], 2.61-4.08; aOR 25-34 years, 2.39; 95% CI, 2.12-2.70; aOR 35-45 years, 2.05; 95% CI, 1.84-2.38). A protective association (odds ratio, 0.8; 95% CI, 0.73-0.98) with oral contraceptive use was noted for PCOS women.CONCLUSION-PCOS might be a predisposing condition for VTE, particularly among women aged 18-24 years. Oral contraceptive use might be protective. Keywordspolycystic ovary syndrome; prevalence; venous thromboembolism Venous thromboembolism (VTE) is a chronic condition that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). Initial presentation might be leg pain, tenderness, shortness of breath, or pleuritic chest pain, or there might be no symptoms. 1 VTE is the third most common cardiovascular disease-after myocardial infarction and stroke-among the general population. 2,3 The overall annual incidence of VTE is estimated © 2012 Mosby, Inc. All rights reserved.Reprints: Ekwutosi M. Okoroh, MD, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E64, Atlanta, GA 30333. Eokoroh@cdc.gov. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.The authors report no conflict of interest.Presented orally at the 60th Annual Epidemic Intelligence Service Conference, Atlanta, GA, April 11-15, 2011. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript to be 1-2 per 1000 adults per year. [4][5][6][7] These incident estimates, however, might not represent the entire population because VTE incidence differs by age and race, and slightly by sex. VTE is a multifactorial disease with both inherited and acquired risk factors. In 26-47% of first-time VTE cases, the etiology is unknown 4,5,8 ; a possible predisposing condition not yet assessed is polycystic ovary syndrome (PCOS).PCOS is the most common endocrine disorder affecting women of reproductive age. Estimates of its prevalence vary and range from 4-6%. 9-12 Its exact etiology is unknown, but it is characterized by a heterogeneous presentation of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. 13 PCOS is also associated with insulin-induced elevations of plasminogen activator inhibitor (P...

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Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003–2008

Okoroh

Hooper

Atrash

et al. 2012

American Journal of Obstetrics and Gynecology

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“…It has been demonstrated that insulin resistance correlates positively with plasma PAI-1 levels (21). Hyperinsulinemia, when present in PCOS, may further increase PAI-1 levels, especially when it acts on the genetic background of homozygosity like 4G/4G.…”

Section: Genotype Subgroups Controlsmentioning

confidence: 99%

The prevalence of 4G5G polymorphism of plasminogen activator inhibitor-1 (PAI-1) gene in polycystic ovarian syndrome and its association with plasma PAI-1 levels

Diamanti-Kandarakis

Palioniko

Alexandraki

et al. 2004

European Journal of Endocrinology

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Objective: To investigate the prevalence of 4G5G polymorphism of plasminogen activator inhibitor-1 (PAI-1) gene in polycystic ovary syndrome (PCOS) and its functional significance. Design: Case-control study. Methods: We studied 98 patients and 64 controls. Body mass index (BMI) and waist-to-hip (WHR) ratio were determined. Blood samples were obtained for DNA analysis. PAI-1 plasma levels, serum total testosterone, fasting insulin and fasting glucose were measured and the glucose-to-insulin ratio was estimated in all subjects.Results: There was a statistically significant difference in the distribution of PAI-1 gene variations among the groups. The PCOS group had significantly higher 4G/4G and 4G/5G combinations than the control group, whereas there were significantly less 5G/5G. Among the PCOS women, 39.8% had the genotype 4G/4G, 39.8% 4G/5G and 20.4% 5G/5G. From the control group, 20.3% had genotype 4G/4G, 28.1% 4G/5G and 51.6% 5G/5G. In the 4G/4G genotype subgroup 75% were PCOS and 25% were controls, in the 4G/5G were 68.42% and 31.58% and in the 5G/5G were 31.58% and 62.26% respectively. The population of PCOS women had significantly higher PAI-1 levels, WHR, total testosterone, and fasting glucose than the population of controls. Conclusions: 1)The genotypic subtypes 4G/4G and 4G/5G, in PCOS, were present with a statistically higher frequency compared with controls. 2)PCOS women have higher levels of PAI-1 compared with the control group. 3)The presence of the 4G allele in PAI-1 promoter region of the gene further increases the PAI-1 levels. 150 793-798 European Journal of Endocrinology

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“…These findings might elucidate some discrepancies regarding fibrinolytic activity in PCOS, as earlier studies indicate both increased PAI-1 activity [15,100,101,160] and normal PAI-1 activity in PCOS patients [102,103] [159]. Thus, it is plausible studies indicating no difference in PAI-1 activity have included a more heterogeneous population of PCOS patients with regard to hyperandrogenism.…”

mentioning

confidence: 74%

“…Increased mass concentration of tPA, as a marker of endothelial disturbances, is possibly a better predictor for coronary heart mortality [98] than PAI-1 activity and is specifically associated with myocardial infarction in young women [99]. The triad obesity, raised triglycerides and, raised insulin levels is the most consistent predictor of impaired fibrinolysis and is often found in PCOS women [15,[100][101][102][103]. Earlier studies on PCOS women suggest both increased and normal levels of PAI-1 activity [15,[100][101][102][103], while studies on tPA-mass in PCOS patients are less ambiguous with increased levels [104][105][106], although at least one study reported unchanged levels [107].…”

Section: Fibrinolysismentioning

confidence: 99%

“…Thus, it is plausible studies indicating no difference in PAI-1 activity have included a more heterogeneous population of PCOS patients with regard to hyperandrogenism. For example, Atiomo et al [102] do not assess biochemical hyperandrogenism and, in two studies [103,159], only high testosterone is used for the assessment of hyperandrogenism. One prior study [100] uses increased FAI as the hyperandrogenism criterion in PCOS patients, while adjusting for BMI, and report increased PAI-1 activity in the PCOS group: this finding is in accordance with the findings of this study.…”

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confidence: 99%

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Metabolic Aspects of Polycystic Ovary Syndrome

2015

Postgraduate Obstetrics & Gynecology

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Raised plasminogen activator inhibitor‐1 (PAI‐1) is not an independent risk factor in the polycystic ovary syndrome (PCOS)

Cited by 62 publications

References 16 publications

Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003–2008

Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003–2008

The prevalence of 4G5G polymorphism of plasminogen activator inhibitor-1 (PAI-1) gene in polycystic ovarian syndrome and its association with plasma PAI-1 levels

Metabolic Aspects of Polycystic Ovary Syndrome

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