The Pluripotential Effects of Hypolipidemic Treatment for Polycystic Ovary Syndrome (PCOS): Dyslipidemia, Cardiovascular Risk Factors and Beyond

Abstract

Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome characterized by oligo- or anovulation, clinical and/or biochemical signs of hyperandrogenemia and polycystic ovaries. Clinical expression is determined by both genetic and environmental factors. Dyslipidemia is very common in lean as well as in obese women with PCOS and should be considered in the therapeutic management of the syndrome. Additionally to dyslipidemia, other risk factors for cardiovascular disease strongly associated with PCOS include insulin resistance, impaired glucose tolerance and metabolic syndrome. Therefore, the ideal therapeutic approach for PCOS would be multi targeted treatment ameliorating not only ovarian dysfunction but also cardiometabolic aspects, including dyslipidemia. Recently, a new era of hypolipidemic agents like statins has been initiated with regard to PCOS. The spectrum of statins' targets has been expanded and in vitro and in vivo studies have explored the specific effect of statins on androgen production, insulin resistance and inflammatory markers in PCOS. Statins are potentially promising therapeutic agents targeting hormonal and metabolic disturbances in PCOS, though conclusive results are still pending. Since several hormonal and metabolic aberrations characterizing this multifaceted syndrome cluster and interact with each other, their effects on the lipid profile are interweaving and the therapeutic modalities targeting dyslipidemia appear to have a more broad beneficial effect.

The effects of old, new and emerging medicines on metabolic aberrations in PCOS

“…Lipid abnormalities are present in 65-81% of PCOS and much higher levels are observed in those with higher insulin resistance [Legro et al 2001]. Genetic, ethnic factors hyperandrogenaemia and obesity are also related with dyslipidemia in women with PCOS [Diamanti-Kandarakis et al 2007; Economou et al 2011].…”

PDGFRA, HSD17B4 and HMGB2 are potential therapeutic targets in polycystic ovarian syndrome and breast cancer

“…Dysregulation of fatty acid metabolism is a typical manifestation of PCOS syndrome, and targeting dyslipidemia appear to have a more beneficial effect [ 22 ]. We demonstrated that through gene-drug interaction network many available drugs that suggested to restore the dysregulation of lipid metabolism are efficient in correcting the abnormal gene expression of HMGB2, PDGFRA and HSD17B4 in PCOS.…”

Targets to treat metabolic syndrome in polycystic ovary syndrome

“…Some studies support pluripotent effects of hypolipidemic treatment on multiple organ systems including cardiovascular risk, hyperandrogenemia, insulin resistance and mood disturbance. [142] There are limitations to the use of statins in women who are attempting pregnancy, or who are pregnant, over concern of fetal teratogenicity [143] with the recommendation of stopping statin treatment prior to attempts at conception. In women with PCOS in whom pregnancy is not a current concern, and in whom therapy is warranted, statins may be considered.…”