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Yamada R, Sachdev D, Lee R, Sauer MV, Ananth CV. Infertility treatment is associated with increased risk of postpartum hospitalization due to heart disease. J Intern Med 2024; 295:668-678. [PMID: 38403886 DOI: 10.1111/joim.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Cardiovascular disease is a major cause of maternal mortality, but the extent to which infertility treatment is implicated in heart disease remains unclear. OBJECTIVE To evaluate the association between infertility treatment and postpartum heart disease. METHODS We designed a retrospective cohort study of patients who delivered in the United States between 2010 and 2018. The primary outcome was hospitalization within 12-month post-delivery due to heart disease (including ischemic heart disease, atherosclerotic heart disease, cardiomyopathy, hypertensive disease, heart failure, and cardiac dysrhythmias). We estimated the rate difference (RD) of hospitalizations among patients who conceived with infertility treatment and those who conceived spontaneously. Associations were expressed as hazard ratios (HRs) and 95% confidence intervals (CIs), derived from Cox proportional hazards regression after adjustment for potential confounders. RESULTS Infertility treatment was recorded in 0.9% (n = 287,813) of 31,339,991 deliveries. Rates of heart disease hospitalizations with infertility treatment and with spontaneous conception were 550 and 355 per 100,000, respectively (RD 195, 95% CI: 143-247; adjusted HR 1.99, 95% CI: 1.80-2.20). The most important increase in risk was observed for hypertensive disease (adjusted HR 2.16, 95% CI: 1.92-2.42). This increased risk was apparent as early as 30-day post-delivery (HR 1.61, 95% CI: 1.39-1.86), with progressively increasing risk up to a year. CONCLUSIONS Although the absolute risk of postpartum heart disease hospitalization is low, infertility treatment is associated with an increased risk, especially for hypertensive disease. These findings highlight the importance of timely postpartum follow-ups in patients who received infertility treatment.
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Affiliation(s)
- Rei Yamada
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Devika Sachdev
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rachel Lee
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mark V Sauer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Cande V Ananth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
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Perusquía M, Herrera N, Jasso-Kamel J, González L, Alejandre N. Hyperandrogenism Protects Against High Blood Pressure by Nongenomic Mechanisms and Obesity Causes Hypertension in Females with Polycystic Ovary Syndrome. Endocr Res 2023; 48:101-111. [PMID: 37598377 DOI: 10.1080/07435800.2023.2249087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/17/2023] [Accepted: 08/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Androgens induce vasorelaxation and reduce blood pressure in different mammals, including humans. Most women with polycystic ovary syndrome (PCOS), with hyperandrogenism, are obese and exhibit hypertension; thus, the fact that androgens increase blood pressure (BP) is controversial. Our aim was to determine whether hypertension is produced by androgen excess and/or obesity. METHODS Experiments were performed in dehydroepiandrosterone; (DHEA, s.c)-induced PCOS model. BP from nonobese and obese rats with PCOS (fed a normal or high-fat diet, respectively) was evaluated weekly for 10 weeks by plethysmography and compared between them. We determined whether androgen receptors are responsible for androgen action on BP in rats with PCOS; a group of DHEA-treated rats was implanted with pellets of an antiandrogen and was compared with nonobese rats with PCOS. Isometric tension from aortas of nonobese and obese rats was recorded and compared to explore the integrity of the vascular endothelium when acetylcholine-induced endothelium-dependent vascular relaxation on phenylephrine contraction. Additionally, BP was obtained from 30 women diagnosed with PCOS: nonobese (BMI ≤25) and obese women (BMI ≥35) and compared with healthy counterparts; 15 obese and 15 nonobese women. RESULTS Nonobese rats and women with PCOS showed hypotension, while obese rats and women with PCOS displayed hypertension. Healthy obese women were hypertensive and nonobese women remained normotensive. Antiandrogen did not modify the BP values in nonobese rats with PCOS, and obese rats with PCOS revealed marked endothelial dysfunction. CONCLUSIONS Our findings show that obesity is responsible for hypertension in PCOS and partial endothelial damage was observed, which may contribute to elevated BP. Remarkably, hyperandrogenism is capable of regulating BP to low values that are androgen receptor-independent.
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Affiliation(s)
- Mercedes Perusquía
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Nieves Herrera
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Jaime Jasso-Kamel
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Lorena González
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Nohemí Alejandre
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
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Pan L, Gao Y, Han J, Li L, Wang M, Peng H, Liao J, Wan H, Xiang G, Han Y. Comparison of longitudinal changes in four surrogate insulin resistance indexes for incident T2DM in middle-aged and elderly Chinese. Front Public Health 2022; 10:1046223. [PMID: 36530691 PMCID: PMC9748338 DOI: 10.3389/fpubh.2022.1046223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
Aims Previous studies suggested a significant relationship between four surrogate indexes of insulin resistance and subsequent type 2 diabetes mellitus (T2DM). But the association of longitudinal changes (denoted as -D) in CVAI (Chinese visceral adiposity index), LAP (lipid accumulation product), TyG (triglyceride-glucose), and TG/HDL-C (triglyceride/ high-density lipoprotein cholesterol) indexes with the risk of T2DM remained uncertain. We aimed to compare the changes in those four surrogate indexes for predicting T2DM in middle-aged and elderly Chinese. Methods We extracted data from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate logistic regression models were used to estimate odds ratio (OR) with 95% confidence interval (CI) of incident T2DM with four surrogate indexes. The restricted cubic spline analysis was used to examine potential non-linear correlation and visualize the dose-response relationship between four indexes and T2DM. The receiver operator characteristic curve was used to compare the performance of the four indexes to predict T2DM. Results We enrolled 4,596 participants in total, including 504 (10.97%) with T2DM. Analysis results showed that four surrogate indexes were associated with T2DM, and the multivariate-adjusted ORs (95% CIs) of T2DM were 1.08 (1.00-1.16), 1.47 (1.32-1.63), 1.12 (1.00-1.25), and 2.45 (2.12-2.83) for each IQR (interquartile range) increment in CVAI-D, LAP-D, TG/HDLC-D, and TyG-D, respectively. Restricted cubic spline regression showed a non-linear correlation between four surrogate indexes and the risk of T2DM (p for non-linear < 0.001). From the ROC (receiver operating characteristic) curve, TyG-D had the highest AUC (area under curve), and its AUC values were significantly different from other three indexes both in male and female (all P < 0.001). Conclusion Compared with other indexes, TyG-D was a better predictor in the clinical setting for identifying middle-aged and elderly Chinese with T2DM. Monitoring long-term changes in TyG might help in the early identification of individuals at high risk of T2DM.
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Affiliation(s)
- Liang Pan
- Phase 1 Clinical Trial Center, Deyang People's Hospital, Sichuan, China
| | - Yu Gao
- College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Han
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Ling Li
- Division of Central Archives, Deyang People's Hospital, Sichuan, China
| | - Miyuan Wang
- School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Hongye Peng
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Juan Liao
- Department of Science and Education, Deyang People's Hospital, Sichuan, China
| | - Hua Wan
- Deyang Maternal and Child Health Service Center, Sichuan, China
| | - Guohua Xiang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yangyun Han
- Deyang People's Hospital, Sichuan, China,*Correspondence: Yangyun Han
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Gupta J, Antal Z, Mauer E, Gerber LM, An A, Censani M. Dysglycemia screening with oral glucose tolerance test in adolescents with polycystic ovary syndrome and relationship with obesity. BMC Endocr Disord 2022; 22:180. [PMID: 35842601 PMCID: PMC9288674 DOI: 10.1186/s12902-022-01098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents with polycystic ovary syndrome (PCOS) are at increased risk of impaired glucose tolerance (IGT) and type 2 diabetes mellitus. The aim of this study is to evaluate dysglycemia and biochemical differences based on BMI status and assess the prognostic ability of elevated hemoglobin A1c (HbA1c) in predicting an abnormal 2 hour oral glucose tolerance test (OGTT). METHODS Retrospective cohort of female patients aged 11-18 years who underwent 75-g OGTT and were evaluated for PCOS at an urban tertiary care hospital between January 2002 to December 2017. RESULTS In 106 adolescents with PCOS who had OGTT results available, IGT was markedly pronounced in the ≥95th percentile BMI group (17 out of 72; 23.6%) compared with <95th percentile BMI group (4 out of 34; 11.7%). One patient with obesity met the criteria for type 2 diabetes. Patients with obesity had significantly higher homeostasis model assessment (HOMA-IR) and lower whole body insulin sensitivity index (WBISI) (p < 0.001) compared to patients without obesity. Free testosterone levels were also higher in patients with obesity (p< 0.03) and were significantly associated with HOMA-IR when controlling for body mass index (BMI). HbA1c did not demonstrate a strong ability to predict abnormal OGTT on receiver operating characteristic (ROC) curve analysis [Area under the curve (AUC) = 0.572, 95% CI: 0.428, 0.939]). CONCLUSIONS In a study to assess glucose abnormalities in adolescents with PCOS, IGT was found to be markedly increased in patients with obesity, with abnormal glucose metabolism identified in over one-fifth of the patients. HbA1c alone may be a poor test to assess IGT and we recommend that adolescents diagnosed with PCOS and obesity undergo formal oral glucose tolerance testing.
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Affiliation(s)
- Jyotsna Gupta
- Department of Pediatrics, Division of Pediatric Endocrinology, New York Presbyterian Hospital, Weill Cornell Medicine, 505 East 70th Street, New York, NY, USA
| | - Zoltan Antal
- Department of Pediatrics, Division of Pediatric Endocrinology, New York Presbyterian Hospital, Weill Cornell Medicine, 505 East 70th Street, New York, NY, USA
| | - Elizabeth Mauer
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, USA
| | - Linda M Gerber
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, USA
| | - Anjile An
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, USA
| | - Marisa Censani
- Department of Pediatrics, Division of Pediatric Endocrinology, New York Presbyterian Hospital, Weill Cornell Medicine, 505 East 70th Street, New York, NY, USA.
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5
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Smith J, Velez MP, Dayan N. Infertility, Infertility Treatment and Cardiovascular Disease: An Overview. Can J Cardiol 2021; 37:1959-1968. [PMID: 34534621 DOI: 10.1016/j.cjca.2021.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022] Open
Abstract
The prevalence of maternal cardiovascular disease (CVD) has risen throughout the developed world, reflecting an increase in acquired cardiovascular risk factors, such as hypertension and diabetes, and the improved life expectancy of those living with congenital CVD due to advances in care. Because many cardiovascular risk factors or cardiovascular conditions are associated with infertility, reproductive-aged women with CVD may increasingly seek reproductive assistance. The worldwide use of assisted reproductive technologies (ART), such as in-vitro fertilization (IVF) with or without intracytoplasmic sperm injection, or intrauterine insemination following pharmacological ovulation induction have increased steadily over the last several decades. It is incumbent among providers who care for reproductive-aged women with pre-existing CVD or CVD risk factors to understand and appreciate the types of treatments offered and inherent risks related to infertility treatments, in order to guide their patients to making safe reproductive choices in line with their values and preferences. While infertility treatments increase the risk of complicated pregnancy, whether these risks are compounded among individuals with pre-existing CVD is less well known. In this review, we summarize current available evidence regarding short-term and long-term cardiovascular implications of ART among individuals with and without CVD, as well as treatment considerations for these women. Existing knowledge gaps and priority areas for further study are presented.
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Affiliation(s)
- Julia Smith
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Natalie Dayan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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6
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Wekker V, van Dammen L, Koning A, Heida KY, Painter RC, Limpens J, Laven JSE, Roeters van Lennep JE, Roseboom TJ, Hoek A. Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis. Hum Reprod Update 2021; 26:942-960. [PMID: 32995872 PMCID: PMC7600286 DOI: 10.1093/humupd/dmaa029] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is associated with cardiometabolic disease, but recent systematic reviews and meta-analyses of longitudinal studies that quantify these associations are lacking. OBJECTIVE AND RATIONALE Is PCOS a risk factor for cardiometabolic disease? SEARCH METHODS We searched from inception to September 2019 in MEDLINE and EMBASE using controlled terms (e.g. MESH) and text words for PCOS and cardiometabolic outcomes, including cardiovascular disease (CVD), stroke, myocardial infarction, hypertension (HT), type 2 diabetes (T2D), metabolic syndrome and dyslipidaemia. Cohort studies and case–control studies comparing the prevalence of T2D, HT, fatal or non-fatal CVD and/or lipid concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs) between women with and without PCOS of ≥18 years of age were eligible for this systematic review and meta-analysis. Studies were eligible regardless of the degree to which they adjusted for confounders including obesity. Articles had to be written in English, German or Dutch. Intervention studies, animal studies, conference abstracts, studies with a follow-up duration less than 3 years and studies with less than 10 PCOS cases were excluded. Study selection, quality assessment (Newcastle–Ottawa Scale) and data extraction were performed by two independent researchers. OUTCOMES Of the 5971 identified records, 23 cohort studies were included in the current systematic review. Women with PCOS had increased risks of HT (risk ratio (RR): 1.75, 95% CI 1.42 to 2.15), T2D (RR: 3.00, 95% CI 2.56 to 3.51), a higher serum concentration of TC (mean difference (MD): 7.14 95% CI 1.58 to 12.70 mg/dl), a lower serum concentration of HDL-C (MD: −2.45 95% CI −4.51 to −0.38 mg/dl) and increased risks of non-fatal cerebrovascular disease events (RR: 1.41, 95% CI 1.02 to 1.94) compared to women without PCOS. No differences were found for LDL-C (MD: 3.32 95% CI −4.11 to 10.75 mg/dl), TG (MD 18.53 95% CI −0.58 to 37.64 mg/dl) or coronary disease events (RR: 1.78, 95% CI 0.99 to 3.23). No meta-analyses could be performed for fatal CVD events due to the paucity of mortality data. WIDER IMPLICATIONS Women with PCOS are at increased risk of cardiometabolic disease. This review quantifies this risk, which is important for clinicians to inform patients and to take into account in the cardiovascular risk assessment of women with PCOS. Future clinical trials are needed to assess the ability of cardiometabolic screening and management in women with PCOS to reduce future CVD morbidity.
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Affiliation(s)
- V Wekker
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - L van Dammen
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Koning
- Department of Gynaecology and Obstetrics, Ziekenhuis Amstelland, Amstelveen, The Netherlands
| | - K Y Heida
- Department of Gynaecology and Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R C Painter
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - J Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J S E Laven
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J E Roeters van Lennep
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - T J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Macut D, Mladenović V, Bjekić-Macut J, Livadas S, Stanojlović O, Hrnčić D, Rašić-Marković A, Milutinović DV, Andrić Z. Hypertension in Polycystic Ovary Syndrome: Novel Insights. Curr Hypertens Rev 2020; 16:55-60. [PMID: 31146668 DOI: 10.2174/1573402115666190531071422] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disease in women during reproductive age. It was shown that PCOS women are with high risk for dyslipidemia, glucose intolerance, type 2 diabetes and metabolic syndrome. These factors are considered to represent traditional risk factors for the occurrence of cardiovascular disease. Observed increased risk for hypertension in PCOS women seems to be associated with insulin resistance and hyperinsulinemia. Both conditions interfere with the endothelium-dependent vasodilatation mechanisms causing vascular muscle wall hypertrophy. Obesity and insulin resistance are considered key factors for the alteration of blood pressure in PCOS women. Higher cardiovascular risk is implicated in PCOS with aging and its consequent association with both systolic and diastolic blood pressure. The elements of renin-angiotensin-aldosterone system (RAAS) have an impact on endothelial dysfunction as a marker of cardiovascular damage that could be modified is women with PCOS. Androgens and components of RAAS are involved in the process of atherogenesis in PCOS women. Therefore, it is hypothesized that spironolactone treatment could ameliorate endothelial dysfunction in PCOS women. Recently it was shown that telmisartan, angiotensin II receptor antagonist poses insulinsensitizing capacity to activate PPAR gamma and mediate favorable metabolic and reproductive effects in hypertensive PCOS women.
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Affiliation(s)
- Djuro Macut
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Violeta Mladenović
- Center for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center Kragujevac, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jelica Bjekić-Macut
- Department of Endocrinology, UMC Bezanijska kosa, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Olivera Stanojlović
- Faculty of Medicine, Institute of Medical Physiology, University of Belgrade, Belgrade, Serbia
| | - Dragan Hrnčić
- Faculty of Medicine, Institute of Medical Physiology, University of Belgrade, Belgrade, Serbia
| | | | | | - Zoran Andrić
- Department of Endocrinology, UMC Bezanijska kosa, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Kataoka J, Larsson I, Björkman S, Eliasson B, Schmidt J, Stener-Victorin E. Prevalence of polycystic ovary syndrome in women with severe obesity - Effects of a structured weight loss programme. Clin Endocrinol (Oxf) 2019; 91:750-758. [PMID: 31529511 DOI: 10.1111/cen.14098] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Existing data are contradictory on the prevalence of polycystic ovary syndrome (PCOS) and metabolic syndrome (MetS) in women with severe obesity (body mass index [BMI] ≥ 35 kg/m2 ), and there are few studies investigating the effect of weight reduction in women with severe obesity and PCOS. The aim was to study the prevalence of PCOS and MetS among women with severe obesity and to evaluate the effect of a 12-months weight loss programme on the prevalence of PCOS and MetS. DESIGN/PARTICIPANTS In total, 298 women with severe obesity were enrolled whereof 246 women had complete screening data for PCOS and MetS before commencing treatment. Weight loss intervention included very low energy diet. At 12-months follow-up, 72 women with complete data remained and were re-examined with baseline parameters. RESULTS At baseline, the prevalence of PCOS was 25.6% and in this group, the prevalence of MetS was 43.4% in PCOS vs 43.3% in controls (ns). At 12-months follow-up, weight loss in women with PCOS was 12.3 ± 10.7 kg (P < .001) and in non-PCOS 13.9 ± 13.4 kg (P < .001) with no between group difference. Women without PCOS decreased in total bone mass. CONCLUSIONS Polycystic ovary syndrome occurs in one out of four women with severe obesity. The prevalence of MetS does not differ between women with or without PCOS with severe obesity. There was a significant weight loss in both groups but no difference between groups regarding change in metabolic parameters.
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Affiliation(s)
- Josefin Kataoka
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingrid Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sofia Björkman
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johanna Schmidt
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabet Stener-Victorin
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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9
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Otaghi M, Azami M, Khorshidi A, Borji M, Tardeh Z. The association between metabolic syndrome and polycystic ovary syndrome: A systematic review and meta-analysis. Diabetes Metab Syndr 2019; 13:1481-1489. [PMID: 31336510 DOI: 10.1016/j.dsx.2019.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND One of the most frequently encountered endocrinopathy in women of reproductive age is polycystic ovary syndrome (PCOS). Recent studies have reported varied prevalence of metabolic syndrome (MetS) in women with PCOS. The aim of this study is to determine if the women with PCOS are at a higher risk of MetS. METHOD The present systematic review and meta-analysis was conducted according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. To collect articles, we searched online databases of PubMed/Medline, Scopus, Web of Science, Science Direct, Embase, CINAHL, Cochrane Library, EBSCO and Google scholar search engine and the reference list of the retrieved articles using MeSH keywords of "metabolic syndrome", "woman" and "polycystic ovary syndrome" without time limit until October 2018. Cochran's Q test and I2 Index were used to evaluate the heterogeneity among studies and the random effects model was used for combining the results. Data analysis was performed in STATA software version 11.1. RESULT Finally, 72 studies involving 10075 PCOS patients with an average age of 26.2 ± 5.01 years were included in the meta-analysis. The heterogeneity rate was high (I2 = 76.5%; p < 0.001) and the pooled estimate of the association between MetS and PCOS was significant (OR = 2.57, 95% CI: 2.18-3.02; P < 0.001). CONCLUSION According to the results, there is higher risk of MetS in women with PCOS. Therefore, diagnosis and treatment of MetS in women with PCOS may have a significant impact on this patients health and reduce the rate of mortality and morbidity.
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Affiliation(s)
- Masoumeh Otaghi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Milad Azami
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Khorshidi
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Milad Borji
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zainab Tardeh
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran.
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Jacewicz-Święcka M, Kowalska I. Polycystic ovary syndrome and the risk of cardiometabolic complications in longitudinal studies. Diabetes Metab Res Rev 2018; 34:e3054. [PMID: 30089337 DOI: 10.1002/dmrr.3054] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 06/18/2018] [Accepted: 07/29/2018] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to perform a review of the longitudinal studies to determine whether polycystic ovary syndrome is associated with higher prevalence of metabolic complications and cardiovascular morbidity and mortality. The primary outcomes included body mass index, metabolic syndrome and its components (waist circumference, lipid profile, arterial hypertension, abnormal glucose metabolism (impaired fasting glucose, impaired glucose tolerance, type 2 diabetes), insulin resistance, and cardiovascular diseases like stroke, angina, and coronary heart disease. Complications in pregnant women were beyond the scope of this review. PubMed database (1992-2018) was searched to identify proper publications. Finally, data from 47 articles were analysed. Studies differed in the design (prospective, retrospective, cohort, observational), research methods, polycystic ovary syndrome diagnostic criteria, studied populations, race, and ethnicity of the participants. Based on the data collected, it appears that women with polycystic ovary syndrome have higher prevalence of obesity, abdominal fat distribution, dyslipidaemia and deterioration of glucose metabolism, but increased prevalence of cardiovascular diseases is not proven.
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Affiliation(s)
- Małgorzata Jacewicz-Święcka
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
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11
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Cooney LG, Dokras A. Beyond fertility: polycystic ovary syndrome and long-term health. Fertil Steril 2018; 110:794-809. [DOI: 10.1016/j.fertnstert.2018.08.021] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 12/30/2022]
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12
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Mu L, Zhao Y, Li R, Lai Y, Qiao J. Metabolic characteristics of normal weight central obesity phenotype polycystic ovary syndrome women: a large-scale national epidemiological survey. Reprod Biomed Online 2018; 37:498-504. [PMID: 30228071 DOI: 10.1016/j.rbmo.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/27/2022]
Abstract
RESEARCH QUESTION The aim was to investigate the metabolic profiles of women with normal weight but central obesity in polycystic ovary syndrome (PCOS). DESIGN In total, 727 women with PCOS from a large-scale epidemiological survey were included. Diagnosis of PCOS was based on Rotterdam criteria. Subjects were categorized into four subgroups: (i) normal weight non-central obesity (NWNCO): body mass index (BMI) ≤18.5 kg/m2 to <25 kg/m2 and waist-to-hip ratio (WHR) <0.85; (ii) normal weight central obesity (NWCO): BMI ≤18.5 kg/m2 to <25 kg/m2 and WHR ≥0.85; (iii) obese non-central obesity (ONCO): BMI ≥25 kg/m2 and WHR <0.85; and (iv) obese central obesity (OCO): BMI ≥25 kg/m2 and WHR ≥0.85. BMI, WHR, blood pressure, glucose and lipid profiles were measured. RESULTS NWCO subjects had significantly higher percentages of insulin resistance, high triglycerides and low high-density lipoprotein cholesterol (HDL-C) than NWNCO subjects (all P < 0.05), and similar percentages compared with ONCO subjects. Compared with the NWNCO group, the NWCO group had higher age-adjusted risks of insulin resistance, high triglycerides and low HDL-C (odds ratio [OR] = 3.83, 95% confidence interval [CI] = 2.23-6.58; OR = 1.66, 95% CI = 1.00-2.77, OR = 1.60, 95% CI = 1.11-2.30, respectively). CONCLUSIONS PCOS women with normal weight but central obesity had increased risks of insulin resistance and dyslipidaemia compared with normal weight PCOS women without central obesity, suggesting that combining BMI with measurement of central obesity may provide better adiposity-related metabolic risk factor stratification in clinical practice than either method alone.
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Affiliation(s)
- Liangshan Mu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third HospitalBeijing, China; National Clinical Research Centre for Obstetrics and GynecologyBeijing, China; Key Laboratory of Assisted Reproduction, Ministry of EducationBeijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, China; Beijing Advanced Innovation Centre for GenomicsBeijing, China; Peking-Tsinghua Centre for Life Sciences, Peking UniversityBeijing, China
| | - Yue Zhao
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third HospitalBeijing, China; National Clinical Research Centre for Obstetrics and GynecologyBeijing, China; Key Laboratory of Assisted Reproduction, Ministry of EducationBeijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, China; Beijing Advanced Innovation Centre for GenomicsBeijing, China; Peking-Tsinghua Centre for Life Sciences, Peking UniversityBeijing, China
| | - Rong Li
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third HospitalBeijing, China; National Clinical Research Centre for Obstetrics and GynecologyBeijing, China; Key Laboratory of Assisted Reproduction, Ministry of EducationBeijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, China; Beijing Advanced Innovation Centre for GenomicsBeijing, China; Peking-Tsinghua Centre for Life Sciences, Peking UniversityBeijing, China
| | - Yuchen Lai
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third HospitalBeijing, China; National Clinical Research Centre for Obstetrics and GynecologyBeijing, China; Key Laboratory of Assisted Reproduction, Ministry of EducationBeijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, China; Beijing Advanced Innovation Centre for GenomicsBeijing, China; Peking-Tsinghua Centre for Life Sciences, Peking UniversityBeijing, China
| | - Jie Qiao
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third HospitalBeijing, China; National Clinical Research Centre for Obstetrics and GynecologyBeijing, China; Key Laboratory of Assisted Reproduction, Ministry of EducationBeijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, China; Beijing Advanced Innovation Centre for GenomicsBeijing, China; Peking-Tsinghua Centre for Life Sciences, Peking UniversityBeijing, China.
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13
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Hallajzadeh J, Khoramdad M, Karamzad N, Almasi-Hashiani A, Janati A, Ayubi E, Pakzad R, Sullman MJM, Safiri S. Metabolic syndrome and its components among women with polycystic ovary syndrome: a systematic review and meta-analysis. J Cardiovasc Thorac Res 2018; 10:56-69. [PMID: 30116503 PMCID: PMC6088762 DOI: 10.15171/jcvtr.2018.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 04/27/2018] [Indexed: 01/24/2023] Open
Abstract
Introduction: The objectives of this study were to provide an estimate of the prevalence of metabolic syndrome (MetS ) and its components among women with PCOS; and calculate the odds ratio (OR) for MetS (using different definitions of MetS) in women with PCOS, compared to healthy controls.
Methods: All of the relevant databases were used to search for appropriate articles that were published during the period 2003-2016. We included observational studies (cross-sectional, comparative cross-sectional) among women who met the inclusion criteria. The random-effect models were used to pool the prevalence of MetS and its components among PCOS women. This model was also applied to the pooled OR assessing the association between MetS and PCOS.
Results: The pooled prevalence of MetS among PCOS women was found to be 26.30% (95% CI: 23.68–28.93), but varied from 7.10% (95% CI: 1.64-12.56) to 37.50% (95% CI: 28.84-46.16), depending upon the diagnostic criteria used. Low high-density lipoprotein cholesterol (HDL) - 61.87% (95% CI: 53.31–70.43) and high waist circumference (WC)- 52.23% (95% CI: 43.84–60.61) were the most common components of MetS in PCOS women. Compared to healthy controls, the overall pooled (OR) of MetS in PCOS patients was 2.09 (95% CI: 1.67-2.60), but this ranged from 0.31 (95% CI: 0.13-0.74) to 4.69 (95% CI: 2.09-10.52), depending upon the diagnostic criteria used.
Conclusion: Women with PCOS had a much higher prevalence of MetS than was found among the healthy controls. Furthermore, as low HDL and high WC were the most common components of MetS in PCOS women, these two components specifically need to be addressed in prevention strategies.
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Affiliation(s)
- Jamal Hallajzadeh
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Maliheh Khoramdad
- Department of Epidemiology and Biostatistics, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nahid Karamzad
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ali Janati
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Erfan Ayubi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Mark J M Sullman
- Middle East Technical University, Northern Cyprus Campus, Güzelyurt/Morphou, Northern Cyprus
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Noroozzadeh M, Farahmand M, Rostami Dovom M, Ramezani Tehrani F. The risk of metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2018; 88:169-184. [PMID: 28930378 DOI: 10.1111/cen.13477] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 09/11/2017] [Accepted: 09/15/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder associated with metabolic syndrome (MetS). The aim of this systematic review and meta-analysis was to provide the most reliable estimate risk of MetS in women with PCOS, compared to healthy controls. METHODS A comprehensive literature search was performed in PubMed [including Medline], Web of Science and Scopus databases for retrieving articles in English language on the prevalence/incidence and odds of MetS in women with PCOS compared to healthy controls. Mantel-Haenszel methods of meta-analysis were used to present results in terms of the pooled odds ratio (OR) (95% confidence interval [CI]) using fixed/random-effects models with/without the publication bias correction, based on the various subgroups of age and study methods. Newcastle-Ottawa Scaling and The Cochrane Collaboration's risk of bias assessment tool were used to evaluate the quality of studies included. RESULTS The search strategy yielded 2759 potentially relevant articles of which 44 articles were included for meta-analysis. Results of the meta-analysis demonstrated that the patients with PCOS regardless of age, BMI and recruitment sources of samples had higher odds of MetS compared to healthy controls (OR 2.5, 95% CI 2.0-3.2). However, adolescents with PCOS had an increased odds of MetS compared to healthy adolescent controls in population- and nonpopulation-based studies (OR 4.7, 95% CI 1.8-11.9; OR 6.1, 95% CI 6.0- 6.1, respectively). However, the odds of MetS had no differences between adults with PCOS compared to healthy controls in population-based studies. These results were confirmed by the subgroup meta-analysis of some studies using age and BMI adjustment/matching. In addition, subgroup analysis based on diagnostic criteria of PCOS showed that the OR of MetS in PCOS using NIH criteria was higher than AES and Rotterdam criteria (Pooled Overall OR based on NIH criteria = 6.05, 95% CIL: 6.0-6.04). CONCLUSION These findings provide some information on the real features and a broader view of this syndrome that also helps clarify conflicting results documented in the literature. Accordingly, in prevention strategies, routine screening for metabolic syndrome is suggested for adolescents with PCOS.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Bidhendi Yarandi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Noroozzadeh
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Farahmand
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Yilmaz B, Vellanki P, Ata B, Yildiz BO. Metabolic syndrome, hypertension, and hyperlipidemia in mothers, fathers, sisters, and brothers of women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertil Steril 2018; 109:356-364.e32. [PMID: 29331234 PMCID: PMC5983376 DOI: 10.1016/j.fertnstert.2017.10.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To provide an evidence-based assessment of metabolic syndrome, hypertension, and hyperlipidemia in first-degree relatives of women with polycystic ovary syndrome (PCOS). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Mothers, fathers, sisters, and brothers of women with and without PCOS. INTERVENTION(S) An electronic-based search with the use of PubMed from 1960 to June 2015 and cross-checked references of relevant articles. MAIN OUTCOME MEASURE(S) Metabolic syndrome, hypertension and dyslipidemia, and surrogate markers, including systolic blood pressure (BP), diastolic BP, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. RESULT(S) Fourteen of 3,346 studies were included in the meta-analysis. Prevalence of the following was significantly increased in relatives of women with PCOS: metabolic syndrome (risk ratio [RR] 1.78 [95% confidence interval 1.37, 2.30] in mothers, 1.43 [1.12, 1.81] in fathers, and 1.50 [1.12, 2.00] in sisters), hypertension (RR 1.93 [1.58, 2.35] in fathers, 2.92 [1.92, 4.45] in sisters), and dyslipidemia (RR 3.86 [2.54, 5.85] in brothers and 1.29 [1.11, 1.50] in fathers). Moreover, systolic BP (mothers, sisters, and brothers), total cholesterol (mothers and sisters), low-density lipoprotein cholesterol (sisters), and triglycerides (mothers and sisters) were significantly higher in first-degree relatives of PCOS probands than in controls. CONCLUSION(S) Our results show evidence of clustering for metabolic syndrome, hypertension, and dyslipidemia in mothers, fathers, sisters, and brothers of women with PCOS. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2016 CRD42016048557.
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Affiliation(s)
- Bulent Yilmaz
- Department of Obstetrics and Gynecology, Izmir Katip Celebi University School of Medicine, Izmir, Turkey
| | - Priyathama Vellanki
- Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia
| | - Baris Ata
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Okan Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
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16
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Luotola K, Piltonen TT, Puurunen J, Morin-Papunen LC, Tapanainen JS. Testosterone is associated with insulin resistance index independently of adiposity in women with polycystic ovary syndrome. Gynecol Endocrinol 2018; 34:40-44. [PMID: 28678568 DOI: 10.1080/09513590.2017.1342793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To study the associations between androgens, glucose homeostasis, inflammation and statin treatment in women with polycystic ovary syndrome (PCOS). DESIGN AND METHODS Oral glucose tolerance tests, androgens, hs-CRP and interleukin-1 receptor antagonist (IL-1Ra) were analyzed at baseline and after 6 months of atorvastatin (20 mg/d) or placebo treatment in 27 women with PCOS. RESULTS Testosterone associated with insulin resistance measured with ISIMatsuda independently of BMI, age and SHBG concentrations and the full model, including IL-1Ra, hs-CRP and HDL-C, also showed independency of BMI and waist circumference (p ≤ .042). Free androgen index (FAI) associated with ISIMatsuda independently of adiposity (p ≤ .025) but in the full model with waist circumference the association was insignificant. ISIMatsuda decreased with testosterone >1.2 nmol/l compared with lower levels at baseline (p = .043) and at six months (p = .003). Accordingly, 30-minute insulin levels were increased with moderately elevated testosterone independently of adiposity (p ≤ .046). Increased fasting glucose and AUC insulin associated with statin treatment independently of adiposity and the associations attenuated after adjusting for testosterone. CONCLUSIONS Moderately elevated testosterone concentrations together with obesity-related inflammatory factors modify glucose homeostasis by increasing insulin resistance and early insulin secretion.
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Affiliation(s)
- Kari Luotola
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
- b Heart and Lung Center, Cardiology , Helsinki University Hospital , Helsinki , Finland
| | - Terhi T Piltonen
- c Department of Obstetrics and Gynecology , Oulu University Hospital, University of Oulu and Medical Research Center and PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology) , Oulu , Finland
| | - Johanna Puurunen
- c Department of Obstetrics and Gynecology , Oulu University Hospital, University of Oulu and Medical Research Center and PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology) , Oulu , Finland
| | - Laure C Morin-Papunen
- c Department of Obstetrics and Gynecology , Oulu University Hospital, University of Oulu and Medical Research Center and PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology) , Oulu , Finland
| | - Juha S Tapanainen
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
- c Department of Obstetrics and Gynecology , Oulu University Hospital, University of Oulu and Medical Research Center and PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology) , Oulu , Finland
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17
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Huddleston HG, Quinn MM, Kao CN, Lenhart N, Rosen MP, Cedars MI. Women with polycystic ovary syndrome demonstrate worsening markers of cardiovascular risk over the short-term despite declining hyperandrogenaemia: Results of a longitudinal study with community controls. Clin Endocrinol (Oxf) 2017; 87:775-782. [PMID: 29044581 DOI: 10.1111/cen.13497] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare age-associated changes in cardiovascular risk markers in lean and obese reproductive-aged women with polycystic ovary syndrome (PCOS) with community controls. DESIGN Longitudinal study at an academic medical centre PATIENTS: Patients diagnosed with PCOS by 2004 Rotterdam criteria in a multidisciplinary clinic were systematically enrolled from 2006-2014 in a PCOS cohort study and subsequently agreed to participate in a longitudinal study. The comparison controls were from the prospective, longitudinal Ovarian Aging (OVA) study, which consists of healthy women with regular menstrual cycles recruited from 2006 to 2011. MEASUREMENTS Cardiovascular risk markers and hormone parameters at baseline and follow-up. RESULTS Obese and lean PCOS (n = 38) and control women (n = 296) completed two study visits. The follow-up time (3.5 ± 1.5 vs 4.0 ± 0.8 years, P = .06) and magnitude of BMI gain (+0.1 kg/m2 /y [-0.11, 0.36] vs +0.26 [-0.18, 0.87] P = .19) did not differ between obese and lean PCOS and controls. In PCOS subjects, total testosterone decreased in both obese and lean, but the decrease was greater in obese subjects (-0.09 nmol/L per year; 95% CI: -0.16, -0.02 vs -0.04 nmol/L per year; 95%CI: -0.11, 0.03). Compared to their respective controls, obese and lean PCOS saw worsening triglyceride (TG) levels (P < .05) and HOMA-IR (P < .05) over time, but there was no difference in change in LDL, HDL, fasting glucose, C-reactive protein or ALT. CONCLUSIONS In a longitudinal study, reproductive-aged women with PCOS demonstrated declines in biochemical hyperandrogenaemia over time. Despite this, PCOS subjects experienced steeper increases in cardiovascular risk factors associated with insulin resistance, including triglycerides and HOMA-IR.
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Affiliation(s)
- Heather G Huddleston
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Molly M Quinn
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Chia-Ning Kao
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Nikolaus Lenhart
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
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18
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Namavar Jahromi B, Dabaghmanesh MH, Parsanezhad ME, Fatehpoor F. Association of leptin and insulin resistance in PCOS: A case-controlled study. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.7.423] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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19
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Sundström Poromaa I, Mellembakken JR, Papunen LM, Piltonen T, Puurunen J, Tapanainen JS, Stener-Victorin E, Hirschberg AL, Vanky E, Ravn P, Glintborg D, Andersen M. Should we individualize lipid profiling in women with polycystic ovary syndrome? Hum Reprod 2016; 31:2791-2795. [DOI: 10.1093/humrep/dew228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/28/2016] [Accepted: 08/02/2016] [Indexed: 12/25/2022] Open
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20
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Ding L, Gao F, Zhang M, Yan W, Tang R, Zhang C, Chen ZJ. Higher PDCD4 expression is associated with obesity, insulin resistance, lipid metabolism disorders, and granulosa cell apoptosis in polycystic ovary syndrome. Fertil Steril 2016; 105:1330-1337.e3. [DOI: 10.1016/j.fertnstert.2016.01.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/31/2015] [Accepted: 01/18/2016] [Indexed: 12/16/2022]
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21
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Kulshreshtha B, Arora A, Pahuja I, Sharma N, Pant S. Menstrual cyclicity post OC withdrawal in PCOS: Use of non-hormonal options. J OBSTET GYNAECOL 2016; 36:833-838. [PMID: 26982394 DOI: 10.3109/01443615.2016.1159667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is no data on menstrual cyclicity post oral contraceptive (OC) withdrawal with nonhormonal options in PCOS patients. OC could affect obesity, insulin and gonadotropins factors integral to pathogenesis of PCOS, thereby adversely affecting the HPG axis. Menstrual cycles of PCOS patients were retrospectively studied post OCP. Patients developing regular versus irregular cycles post OC were compared. Forty-eight PCOS patients were followed for an average of 1.9 years post OC. Thirty-six (75%) achieved regular cycles over a period of one year with other nonhormonal options like spironolactone and metformin. Seven patients required no treatment. Patients who continued to have irregular cycles had a longer pre OC cycle length (p < 0.01) and a greater duration of menstrual irregularity (p < 0.02), though age, BMI and hormones were similar in the two groups. In conclusion, spironolactone and metformin are effective nonhormonal options for regular periods post OC. Around 15% PCOS may not require any treatment post OC.
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Affiliation(s)
| | | | | | - Neera Sharma
- b Department of Biochemistry , PGIMER, Dr RML Hospital , Delhi, India
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22
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Ramezani Tehrani F, Montazeri SA, Hosseinpanah F, Cheraghi L, Erfani H, Tohidi M, Azizi F. Trend of Cardio-Metabolic Risk Factors in Polycystic Ovary Syndrome: A Population-Based Prospective Cohort Study. PLoS One 2015; 10:e0137609. [PMID: 26360602 PMCID: PMC4567354 DOI: 10.1371/journal.pone.0137609] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/19/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To see the changes of cardio-metabolic risk factors overtime in polycystic ovary syndrome vs. control women. METHODS This study was conducted on 637 participants (85 PCOS and 552 control reproductive aged, 18-45 years) of Tehran Lipid and Glucose Study (TLGS), an ongoing population-based cohort study with 12 years of follow-up. The cardiovascular risk factors of these groups were assessed in three-year intervals using standard questionnaires, history taking, anthropometric measures, and metabolic/endocrine evaluation. Generalized estimating equation was used to analyze the data. RESULTS Overall mean of insulin (3.55, CI: 0.66-6.45), HOMA-IR (0.63, CI: 0.08-1.18), and HOMA-β (45.90, CI: 0.86-90.93) were significantly higher in PCOS than in healthy women after adjustment for age, BMI, and baseline levels. However, the negative interaction (follow-up years × PCOS status) of PCOS and normal women converged overtime. Comparing third follow-up with first, insulin and HOMA-IR decreased 10.6% and 5%, respectively in PCOS women; and increased 6.7% and 14.6%, respectively in controls (P<0.05). The results did not show any significant result for other cardio-metabolic variables including WC, lipid profile, FPG, 2-h PG, SBP, and DBP. CONCLUSION While the insulin level and insulin resistance rate were higher in reproductive aged PCOS than in healthy women, the difference of these risk factors decreased overtime. Thus, the metabolic consequences of PCOS women in later life may be lower than those initially anticipated.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Montazeri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Erfani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gaberšček S, Zaletel K, Schwetz V, Pieber T, Obermayer-Pietsch B, Lerchbaum E. Mechanisms in endocrinology: thyroid and polycystic ovary syndrome. Eur J Endocrinol 2015; 172:R9-21. [PMID: 25422352 DOI: 10.1530/eje-14-0295] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Thyroid disorders, especially Hashimoto's thyroiditis (HT), and polycystic ovary syndrome (PCOS) are closely associated, based on a number of studies showing a significantly higher prevalence of HT in women with PCOS than in controls. However, the mechanisms of this association are not as clear. Certainly, genetic susceptibility contributes an important part to the development of HT and PCOS. However, a common genetic background has not yet been established. Polymorphisms of the PCOS-related gene for fibrillin 3 (FBN3) could be involved in the pathogenesis of HT and PCOS. Fibrillins influence the activity of transforming growth factor beta (TGFβ). Multifunctional TGFβ is also a key regulator of immune tolerance by stimulating regulatory T cells (Tregs), which are known to inhibit excessive immune response. With lower TGFβ and Treg levels, the autoimmune processes, well known in HT and assumed in PCOS, might develop. In fact, lower levels of TGFβ1 were found in HT as well as in PCOS women carrying allele 8 of D19S884 in the FBN3 gene. Additionally, vitamin D deficiency was shown to decrease Tregs. Finally, high estrogen-to-progesterone ratio owing to anovulatory cycles in PCOS women could enhance the immune response. Harmful metabolic and reproductive effects were shown to be more pronounced in women with HT and PCOS when compared with women with HT alone or with controls. In conclusion, HT and PCOS are associated not only with respect to their prevalence, but also with regard to etiology and clinical consequences. However, a possible crosstalk of this association is yet to be elucidated.
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Affiliation(s)
- Simona Gaberšček
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Katja Zaletel
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Verena Schwetz
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Thomas Pieber
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Barbara Obermayer-Pietsch
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Elisabeth Lerchbaum
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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24
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Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, Kelestimur F, Macut D, Micic D, Pasquali R, Pfeifer M, Pignatelli D, Pugeat M, Yildiz BO. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 2014; 171:P1-29. [PMID: 24849517 DOI: 10.1530/eje-14-0253] [Citation(s) in RCA: 363] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.
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Affiliation(s)
- Gerard Conway
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Didier Dewailly
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Evanthia Diamanti-Kandarakis
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Héctor F Escobar-Morreale
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Stephen Franks
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alessandra Gambineri
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Fahrettin Kelestimur
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Djuro Macut
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Dragan Micic
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Renato Pasquali
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marija Pfeifer
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Duarte Pignatelli
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Michel Pugeat
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bulent O Yildiz
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Abstract
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in the reproductive age group; it is characterized by oligo-ovulation or anovulation, hyperandrogenism and the presence of polycystic ovaries. It affects 8-10% of women in the reproductive age group and its main presentations are irregular periods, hirsutism and infertility in this group. Women with PCOS have impaired glucose tolerance, dyslipidemia, and increased risk of type 2 diabetes and metabolic syndrome. The phenotype of PCOS in menopausal women is difficult to define. Studies have included previous history of oligomenorrhea, infertility and hyperandrogenism (clinical or biochemical) to describe the phenotype for postmenopausal women. Hyperandrogenism seen in PCOS women persists after the menopausal transition. Similarly, PCOS women continue to manifest the metabolic alterations such as insulin resistance after menopause, which makes them more susceptible to type 2 diabetes mellitus. The metabolic syndrome occurs more often in women with PCOS and has been shown to be associated with increased risk of cardiovascular disease. Whether PCOS itself causes an increased cardiovascular disease risk later in life is still uncertain. This dilemma needs to be solved since young women with PCOS may be required to undergo expensive investigations and screening for cardiovascular disease, whilst their true disease risk is still unknown.
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Affiliation(s)
- D Shah
- Gynaecworld , Kwality House, Mumbai , India
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26
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Pan PP, Zhan QT, Le F, Zheng YM, Jin F. Angiotensin-converting enzymes play a dominant role in fertility. Int J Mol Sci 2013; 14:21071-86. [PMID: 24152441 PMCID: PMC3821659 DOI: 10.3390/ijms141021071] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 10/14/2013] [Accepted: 10/14/2013] [Indexed: 01/10/2023] Open
Abstract
According to the World Health Organization, infertility, associated with metabolic syndrome, has become a global issue with a 10%-20% incidence worldwide. An accumulating body of evidence has shown that the renin-angiotensin system is involved in the fertility problems observed in some populations. Moreover, alterations in the expression of angiotensin-converting enzyme-1, angiotensin-converting enzyme-2, and angiotensin-converting enzyme-3 might be one of the most important mechanisms underlying both female and male infertility. However, as a pseudogene in humans, further studies are needed to explore whether the abnormal angiotensin-converting enzyme-3 gene could result in the problems of human reproduction. In this review, the relationship between angiotensin-converting enzymes and fertile ability is summarized, and a new procedure for the treatment of infertility is discussed.
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Affiliation(s)
- Pei-Pei Pan
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou 310006, China; E-Mails: (P.-P.P.); (Q.-T.Z.); (F.L.); (Y.-M.Z.)
| | - Qi-Tao Zhan
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou 310006, China; E-Mails: (P.-P.P.); (Q.-T.Z.); (F.L.); (Y.-M.Z.)
| | - Fang Le
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou 310006, China; E-Mails: (P.-P.P.); (Q.-T.Z.); (F.L.); (Y.-M.Z.)
| | - Ying-Ming Zheng
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou 310006, China; E-Mails: (P.-P.P.); (Q.-T.Z.); (F.L.); (Y.-M.Z.)
| | - Fan Jin
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou 310006, China; E-Mails: (P.-P.P.); (Q.-T.Z.); (F.L.); (Y.-M.Z.)
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27
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Erdogan E, Akkaya M, Turfan M, Batmaz G, Bacaksız A, Tasal A, Ilhan M, Kul S, Sönmez O, Vatankulu MA, Tasan E. Polycystic ovary syndrome is associated with P-wave prolongation and increased P-wave dispersion. Gynecol Endocrinol 2013; 29:830-3. [PMID: 23855355 DOI: 10.3109/09513590.2013.813474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The polycystic ovary syndrome (PCOS) is associated with various cardiac manifestations including cardiac arrhythmias. P-wave dispersion (Pdis) is an appealing marker for predicting the risk of developing atrial arrhythmias. The purpose of this study was to evaluate P-wave durations and Pdis in patients with PCOS. METHODS Forty adult patients with PCOS and 46 age- and sex-matched healthy individuals were included in this study. P-wave maximum duration (Pmax) and P-wave minimum duration (Pmin) were calculated on the 12-lead electrocardiogram, and the difference between the Pmax and the Pmin was defined as Pdis. All individuals also underwent transthoracic echocardiographic evaluation. RESULTS Pmax and Pdis were significantly higher in patients with PCOS compared with controls (p = 0.007, p < 0.001, respectively). There was no difference in Pmin duration between both the groups (p = 0.2). Waist-to-hip ratio, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were higher in the PCOS group. Early mitral inflow deceleration time (DT) (p < 0.001) and isovolumetric relaxation time (p = 0.003) were longer in PCOS group. Waist-to-hip ratio, DT, E/A ratio and diastolic blood pressure correlated with Pdis. CONCLUSIONS Patients with PCOS have prolonged Pmax and Pdis. The increase in those parameters may be an indicator for identification of patients at increased risk of atrial fibrillation.
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Affiliation(s)
- Ercan Erdogan
- Bezmialem Vakif University, Faculty of Medicine, Department of Cardiology, 34093 Fatih/Istanbul, Turkey.
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Carmina E, Campagna AM, Lobo RA. Emergence of ovulatory cycles with aging in women with polycystic ovary syndrome (PCOS) alters the trajectory of cardiovascular and metabolic risk factors. Hum Reprod 2013; 28:2245-52. [PMID: 23595974 DOI: 10.1093/humrep/det119] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION What alters cardiovascular and metabolic risk factors with aging in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Lipid parameters, mainly low-density lipoprotein (LDL) cholesterol, increase with aging, but not in women who attain ovulatory cycles. WHAT IS KNOWN ALREADY Cardiovascular and metabolic parameters tend to increase with aging, but this has not been shown in a prospective longitudinal study in women with PCOS. Correlates of these changes have not been identified. STUDY DESIGN A prospective cohort of 118 hyperandrogenic women with PCOS who were followed from the age of 20-25 years at 5 year intervals for 20 years. PARTICIPANTS/MATERIALS, SETTING, METHODS Thirty-five age-matched controls and another 35 age-matched controls in their 40s, 20 years later. Longitudinal measurements of body mass index (BMI), waist circumference, fasting serum steroids, glucose, insulin, lipids, prevalence of metabolic syndrome and ovulatory status. MAIN RESULTS AND THE ROLE OF CHANCE After 20 years, in the entire group, waist circumference increased as did glucose, total cholesterol (C), high-density lipoprotein-C (HDL-C), LDL-C and non-HDL-C. The prevalence of metabolic syndrome was 7% at the beginning and 6% at the end. Fifty-one women with PCOS were found to be ovulatory and 67 remained anovulatory after 20 years. Anovulatory women had higher insulin, lower QUICKI and higher total C, LDL-C, non-HDL-C and lower HDL-C. In ovulatory women there were no alterations in lipids or glucose and minor changes in insulin and QUICKI compared with controls. None of the parameters were influenced by BMI or waist circumference. LIMITATIONS, REASONS FOR CAUTION Inability to follow controls for 20 years. Associations observed between ovulatory function and lowered cardiovascular and metabolic risks cannot imply cause and effect. WIDER IMPLICATIONS OF THE FINDINGS Phenotypic variability, particularly ovulatory function, in women diagnosed to have PCOS appears to influence cardiovascular and metabolic risks. It is unclear if these data pertain to other populations and ethnicities of women. STUDY FUNDING/COMPETING INTERESTS Self-funded; no conflicts of interest.
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Affiliation(s)
- E Carmina
- DISMOT Department, University of Palermo, Palermo, Italy
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29
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Psoriatic patients have an increased risk of polycystic ovary syndrome: results of a cross-sectional analysis. Fertil Steril 2013; 99:936-42. [DOI: 10.1016/j.fertnstert.2012.10.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/18/2012] [Accepted: 10/21/2012] [Indexed: 12/11/2022]
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Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev 2013; 14:95-109. [PMID: 23114091 DOI: 10.1111/j.1467-789x.2012.01053.x] [Citation(s) in RCA: 307] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/02/2012] [Accepted: 09/13/2012] [Indexed: 12/14/2022]
Abstract
While many women with polycystic ovary syndrome (PCOS) are overweight, obese or centrally obese, the effect of excess weight on the outcomes of PCOS is inconsistent. The review aimed to assess the effects of overweight, obesity and central obesity on the reproductive, metabolic and psychological features of PCOS. MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and PSYCINFO were searched for studies reporting outcomes according to body mass index categories or body fat distribution. Data were presented as mean difference or risk ratio (95% confidence interval). This review included 30 eligible studies. Overweight or obese women with PCOS had decreased sex hormone-binding globulin (SHBG), increased total testosterone, free androgen index, hirsutism, fasting glucose, fasting insulin, homeostatic model assessment-insulin resistance index and worsened lipid profile. Obesity significantly worsened all metabolic and reproductive outcomes measured except for hirsutism when compared to normal weight women with PCOS. Overweight women had no differences in total testosterone, hirsutism, total-cholesterol and low-density lipoprotein-cholesterol compared to normal weight women and no differences in SHBG and total testosterone compared to obese women. Central obesity was associated with higher fasting insulin levels. These results suggest that prevention and treatment of obesity is important for the management of PCOS.
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Affiliation(s)
- S S Lim
- The Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia
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31
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Zhu JP, Teng YC, Zhou J, Lu W, Tao MF, Jia WP. Increased mean glucose levels in patients with polycystic ovary syndrome and hyperandrogenemia as determined by continuous glucose monitoring. Acta Obstet Gynecol Scand 2012; 92:165-71. [PMID: 23072215 DOI: 10.1111/aogs.12031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Women with polycystic ovary syndrome are at risk of developing type 2 diabetes mellitus. This study aimed to evaluate the influence of hyperandrogenemia on glucose metabolism in polycystic ovarian syndrome patients. DESIGN Cohort study. SETTING Reproductive Endocrinology Clinic of the Shanghai Sixth People's Hospital. SAMPLE Fifty-three patients were recruited from June 2008 to December 2009, including 28 women with hyperandrogenism and 25 without hyperandrogenemia. METHODS Anthropometric parameters, including weight, height, body mass index and waist-to-hip ratio, as well as sex hormones, were measured. An oral glucose tolerance test, including fasting and two hour glucose and insulin levels, was recorded. Insulin resistance was evaluated by homeostatic model assessment of insulin resistance, and patients underwent continuous glucose monitoring. MAIN OUTCOME MEASURES Mean blood glucose level, mean amplitude of glycemic excursion, frequency of glycemic excursion and the percentage of time of hypoglycemia and hyperglycemia during a 48 h period. RESULTS No differences in age, body mass index, waist-to-hip ratio, fasting and two hour glucose and insulin concentrations were observed between the groups. The hyperandrogenism group had higher levels of luteinizing hormone and dehydroepiandrosterone sulfate (p < 0.05). However, continuous glucose monitoring showed that the minimal blood glucose and mean blood glucose were significantly higher in hyperandrogenemia group (p = 0.004). The percentage of time for hypoglycemia (≤70 mg/dL) was higher in the hyperandrogenemia group (p = 0.002). CONCLUSIONS Polycystic ovarian syndrome patients with hyperandrogenemia had an increased mean glucose value, which may place them at increased risk for developing type 2 diabetes.
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Affiliation(s)
- Jie-Ping Zhu
- Department of Obstetrics and Gynecology, the Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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32
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Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2012; 18:618-37. [PMID: 22767467 DOI: 10.1093/humupd/dms030] [Citation(s) in RCA: 482] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is closely associated with obesity but the prevalence of obesity varies between published studies. The objective of this research was to describe the prevalence of overweight, obesity and central obesity in women with and without PCOS and to assess the confounding effect of ethnicity, geographic regions and the diagnostic criteria of PCOS on the prevalence. METHODS MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and PSYCINFO were searched for studies reporting the prevalence of overweight, obesity or central obesity in women with and without PCOS. Data were presented as prevalence (%) and risk ratio (RR) [95% confidence interval (CI)]. Random-effect models were used to calculate pooled RR. RESULTS This systematic review included 106 studies while the meta-analysis included 35 studies (15129 women). Women with PCOS had increased prevalence of overweight [RR (95% CI): 1.95 (1.52, 2.50)], obesity [2.77 (1.88, 4.10)] and central obesity [1.73 (1.31, 2.30)] compared with women without PCOS. The Caucasian women with PCOS had a greater increase in obesity prevalence than the Asian women with PCOS compared with women without PCOS [10.79 (5.36, 21.70) versus 2.31 (1.33, 4.00), P < 0.001 between subgroups). CONCLUSIONS Women with PCOS had a greater risk of overweight, obesity and central obesity. Although our findings support a positive association between obesity and PCOS, our conclusions are limited by the significant heterogeneity between studies and further studies are now required to determine the source of this heterogeneity. Clinical management of PCOS should include the prevention and management of overweight and obesity.
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Affiliation(s)
- S S Lim
- The Robinson Institute, University of Adelaide, Adelaide, Australia
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