Risk Factors for Coronary Artery Disease in Lean and Obese Women With Polycystic Ovary Syndrome

Abstract

OBJECTIVE The evidence that some women wlth the polycystlc ovary syndrome (PCOS) are hyperinsuiinaemlc has brought into question their rlsk of developing early coronary artery disease. We have focused on three cardiac risk factors which have been associated with hyperlnsulinaemla by measuring glucose tolerance, fasting serum llpld concentrations and blood pressure In women with PCOS. DESIGN Comparison of cllnlcal and biochemical measurements in lean and obese women with PCOS and in women wlth normal ovaries. Determinants of the risk factors for coronary artery disease were assessed by multiple regresslon analysis. PATIENTS One hundred and two women with ultrasound diagnosed PCOS and 19 lean women wlth normal ovaries were studled. Patients were recruited from a reproductlve endocrine cilnlc. MEASUREMENTS Fasting total cholesterol, trlglycerides, high density lipoproteins (HDL), HDL2, glucose tolerance, fasting and stimulated insulin, gonadotrophins, testosterone and androstenedlone were measured during a 2hour oral glucose tolerance test. Recumbent blood pressure was measured automatlcaliy. RESULTS Lean women wlth PCOS were found to be hyperinsulinaemlc and have reduced serum HDL and HDLz concentrations compared to women with normal ovaries; serum insulin concentrations correlated positively with plasma glucose and blood pressure measurements in multiple regression analysis. Obese women with PCOS were in addition found to have higher systollc blood pressure, serum trlglyceride and plasma glucose concentration than lean women with PCOS and controls.CONCLUSiONS These results support the evidence that hyperinsullnaemlc women wlth PCOS have an Increased rlsk of developing cardiovascular dlsease and therefore form a population in whom metabolic screenlng is advisable.

Effects of oral fat and glucose tolerance test on serum lipid profile, apolipoprotein, and CRP concentration, and insulin resistance in patients with polycystic ovary syndrome

“…Diabetic subjects (n ϭ 9), smokers (n ϭ 5), alcohol users (n ϭ 1), and those taking sex hormones or drugs known to affect lipid metabolism and C-reactive protein (CRP) levels during the 2 months preceding the study (n ϭ 15) were excluded. All the patients had a hirsutism score of 11 or more (range of [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Subjects with Cushing's syndrome (n ϭ 1), ovarian or adrenal secreting tumor (n ϭ 0), and other diseases such as nonclassic congenital adrenal hyperplasia (n ϭ 2), hypertension (n ϭ 7), drug-induced hirsutism (n ϭ 0), or any previous illness contraindicating the use of any drugs (n ϭ 0) were not included to the study.…”

“…In women, cardiovascular disease is the most common cause of death (7), and those with PCOS have a 7.4-fold relative risk for myocardial infarction calculated by risk factor analysis because of the prevalence of glucose intolerance, hypertension, insulin resistance (8 -11), central obesity (12), and dyslipidemia. The latter is characterized by low high-density lipoprotein (HDL) cholesterol and raised triglycerides (13,14), and may explain their cardiovascular risk (15), particularly as low HDL cholesterol appears to be the most important lipoprotein predictor of coronary heart disease (CHD) in women (16). Pathogenesis of dyslipidemia in PCOS remains controversial.…”

Oxidative stress and cardiovascular complications in polycystic ovarian syndrome

“…Carotid intima-media thickness is another surrogate marker for early atherogenic process that has also been found to be increased in PCOS compared with the agematched control [80]. A large body of evidence indicate that the prevalence of metabolic syndrome and coronary artery disease (CAD) is higher in PCOS [2,4,44,[80][81][82][83][84][85][86][87][88][89][90]. These findings unmask the increased risk of PCOS women for adverse cardiovascular outcomes and mortality.…”

Serum paraoxonase 1 activity, asymmetric dimethylarginine levels, and brachial artery flow-mediated dilatation in women with polycystic ovary syndrome

“…Most women with polycystic ovary syndrome (PCOS) have a clustering of cardiovascular risk factors such as obesity, dyslipidemia, impaired glucose tolerance, insulin resistance, and hypertension (1,2). Cardiovascular risk factors and cardiovascular abnormalities are often evident at an early age, and abnormal hormonal and metabolic status from adolescence may predispose these women to premature atherosclerosis, making them candidates for early cardiovascular disease.…”