Unfavorable Hormonal, Metabolic, and Inflammatory Alterations Persist after Menopause in Women with PCOS

Puurunen, Johanna; Piltonen, Terhi; Morin‐Papunen, Laure; Perheentupa, Antti; Järvelä, Ilkka Y.; Ruokonen, Aimo; Tapanainen, Juha S.

doi:10.1210/jc.2011-0039

Cited by 95 publications

(55 citation statements)

References 46 publications

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“…Although these studies did not distinguish between women with a history of irregular menses or PCOS, the above data have implications for the cardiometabolic role of hyperandrogenemia, which persists after menopause in PCOS women (8).…”

Section: Introductionmentioning

confidence: 85%

MECHANISMS IN ENDOCRINOLOGY: Recent advances in cardiovascular aspects of polycystic ovary syndrome

Sathyapalan

Atkin²

2012

European Journal of Endocrinology

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Polycystic ovary syndrome (PCOS) has been associated with increased cardiovascular risk (CVR) markers, but population studies have not clarified whether there is an increase in cardiovascular morbidity and mortality. Four different PCOS phenotypes resulted from the Rotterdam criteria that may differ in their CVR potential, thus introducing further complexity. This has led to studies using surrogate CVR markers including biomarkers in blood and imaging such as flow-mediated vasodilatation. In PCOS, both peripheral and central insulin resistance (IR) have been shown. Weight loss has been shown to improve IR and visceral fat, while insulin sensitizer therapies with metformin or thiazolidinediones improve IR and endothelial dysfunction. IR is also found in non-alcoholic fatty liver disease that in turn is very common in PCOS; studies have suggested that IR may be improved by treatment with metformin and omega-3 fish oils. PCOS patients have a more dyslipidemic phenotype that is worse in 'classical PCOS' associated with a higher CVR. Studies with atorvastatin and simvastatin have reported a decrease in the lipid parameters and an improvement in CVR indices including IR, but it is unclear whether this is due to their lipid-lowering action or a pleiotropic effect of the statin. In this expert opinion review, the relevant literature published during the last 2 years was considered. It focuses on some recent important data that has emerged while also exposing the gaps that remain in our knowledge that need to be addressed.

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Section: Introductionmentioning

confidence: 85%

MECHANISMS IN ENDOCRINOLOGY: Recent advances in cardiovascular aspects of polycystic ovary syndrome

Sathyapalan

Atkin²

2012

European Journal of Endocrinology

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“…Moreover, exclusively in this group correlations between proinsulin and hsCRP and proinsulin and FAI are observed and metformin causes significant decreases in proinsulin and androstenedione levels solely in obese/overweight PCOS patients. It has been noted repeatedly that PCOS per se is an independent risk factor of insulin resistance [16][17][18] and that obese PCOS women have different metabolic and hormonal parameters than lean PCOS patients [19]. Pasquali et al demonstrated [20] that obese PCOS women are characterised by worse insulin resistance than lean PCOS patients.…”

Section: Discussionmentioning

confidence: 99%

Proinsulina, adiponektyna i hsCRP u kobiet w wieku rozrodczym z zespołem policystycznych jajników (PCOS) — wpływ leczenia metforminą

Kruszyńska¹,

Słowińska-Srzednicka²,

Jeske³

et al. 2014

Endokrynologia Polska

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Introduction: Women with polycystic ovary syndrome (PCOS) often suffer from obesity and insulin resistance. The role of proinsulin, which is known to be an indicator of fertility outcomes in PCOS women, and that of adiponectin, in the pathogenesis of PCOS is not well elucidated. Our objective was to determine proinsulin, adiponectin, hsCRP and other hormonal and metabolic parameters in PCOS women before and after metformin treatment. Material and methods: Two PCOS groups of patients of reproductive age (90 lean and 88 obese or overweight) with two control groups, adjusted for body mass index (BMI), were compared at baseline. 32 PCOS women were studied at baseline, after three and six months of metformin (1,000 mg/day) treatment. Clinical, anthropometric, biochemical and hormonal parameters were assessed. Results: Proinsulin and hsCRP levels were the highest in obese PCOS women and were statistically different than in lean PCOS women (proinsulin: 11.4 v. 6.9 pmol/L; hsCRP 2.46 v. 0.47 mg/L, p < 0.01) and than in obese controls. Levels of adiponectin were dependant on BMI. Plasma proinsulin and androstenedione levels decreased after metformin treatment only in obese PCOS women. Conclusions: PCOS, when accompanied by obesity, is associated with elevated proinsulin concentrations, which correlates with higher hsCRP and increased FAI. Proinsulin level decreases due to metformin treatment. Our results suggest that obese or overweight PCOS and lean PCOS are characterised by different hormonal and metabolic parameters and have a different response to metformin treatment.

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“…However, androgen excess, as well as a proinflammatory profile, further aggravates the cardiovascular and metabolic aberrations in women with PCOS (38,153). Women with PCOS harbor a twofold increased risk for arterial disease (coronary heart and stroke), independent of their body mass index (43).…”

Section: Is Testosterone a Good Or Bad Guy For Cardiovascular Systemsmentioning

confidence: 99%

Reactive oxygen species: players in the cardiovascular effects of testosterone

Tostes

Carneiro

Carvalho

et al. 2016

American Journal of Physiology-Regulatory, Integrative and Comp

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Tostes RC, Carneiro FS, Carvalho MH, Reckelhoff JF. Reactive oxygen species: players in the cardiovascular effects of testosterone. Am J Physiol Regul Integr Comp Physiol 310: R1-R14, 2016. First published November 4, 2015 doi:10.1152/ajpregu.00392.2014.-Androgens are essential for the development and maintenance of male reproductive tissues and sexual function and for overall health and well being. Testosterone, the predominant and most important androgen, not only affects the male reproductive system, but also influences the activity of many other organs. In the cardiovascular system, the actions of testosterone are still controversial, its effects ranging from protective to deleterious. While early studies showed that testosterone replacement therapy exerted beneficial effects on cardiovascular disease, some recent safety studies point to a positive association between endogenous and supraphysiological levels of androgens/testosterone and cardiovascular disease risk. Among the possible mechanisms involved in the actions of testosterone on the cardiovascular system, indirect actions (changes in the lipid profile, insulin sensitivity, and hemostatic mechanisms, modulation of the sympathetic nervous system and renin-angiotensin-aldosterone system), as well as direct actions (modulatory effects on proinflammatory enzymes, on the generation of reactive oxygen species, nitric oxide bioavailability, and on vasoconstrictor signaling pathways) have been reported. This mini-review focuses on evidence indicating that testosterone has prooxidative actions that may contribute to its deleterious actions in the cardiovascular system. The controversial effects of testosterone on ROS generation and oxidant status, both prooxidant and antioxidant, in the cardiovascular system and in cells and tissues of other systems are reviewed. cardiovascular; prooxidant; antioxidant TESTOSTERONE 1 IS THE PREDOMINANT and most important androgen, playing a major role in the development of male reproductive tissues (130,135). "Androgen" is a broad term for any natural or synthetic compound that primarily influences the growth and development of the male reproductive system, including the activity of the accessory male sex organs and development of male secondary sex characteristics (21, 135). Androgens are also essential for health and well being, and their beneficial and stimulant effects have been known for a long time, since the seminal studies from Brown-Séquard in the nineteenth century 2 (22, 135): "ь ь ь in the seminal fluid, as secreted by the testicles, a substance or several substances exist which, entering the blood by resorption, have a most essential use in giving strength to the nervous system and to other parts ь ь ь ."Other androgens include androstenedione, 5␣-dihydrotestosterone (DHT), which is produced from testosterone by the enzyme 5␣-reductase, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), and synthetic androgens in their many steroid ester variations (e.g., testosterone cypionate, decanoate, undecanoate, enant...

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Unfavorable Hormonal, Metabolic, and Inflammatory Alterations Persist after Menopause in Women with PCOS

Abstract: The results indicate that impaired glucose metabolism, enhanced ovarian androgen secretion, and chronic inflammation observed in pre-MP women with PCOS persist after menopausal transition emphasizing life-long health risks related to this syndrome.

Cited by 95 publications

References 46 publications

MECHANISMS IN ENDOCRINOLOGY: Recent advances in cardiovascular aspects of polycystic ovary syndrome

MECHANISMS IN ENDOCRINOLOGY: Recent advances in cardiovascular aspects of polycystic ovary syndrome

Proinsulina, adiponektyna i hsCRP u kobiet w wieku rozrodczym z zespołem policystycznych jajników (PCOS) — wpływ leczenia metforminą

Reactive oxygen species: players in the cardiovascular effects of testosterone

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