1
|
Profili NI, Castelli R, Gidaro A, Manetti R, Maioli M, Petrillo M, Capobianco G, Delitala AP. Possible Effect of Polycystic Ovary Syndrome (PCOS) on Cardiovascular Disease (CVD): An Update. J Clin Med 2024; 13:698. [PMID: 38337390 PMCID: PMC10856325 DOI: 10.3390/jcm13030698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women during the fertile period. Women with PCOS have an increased risk of developing major cardiovascular risk factors during the fertile period: obesity, impaired glucose tolerance, diabetes mellitus, dyslipidemia, and metabolic syndrome. The possible effect of PCOS on cardiovascular disease (CVD) has been reported in different studies, but the results are not clear for several reasons. Indeed, most of the studies analyzed a cohort of fertile women who, given their relatively young age, have a low frequency of cardiovascular diseases. In addition, longitudinal studies have a short follow-up period, insufficient to draw firm conclusions on this topic. Finally, pharmacological treatment is limited by the lack of specific drugs available to specifically treat PCOS. In this review, we report on studies that analyzed the possible effect of PCOS on the most common CVD (hypertension, arterial stiffness, atherosclerosis, and cardiovascular event) and available drugs used to reduce CVD in PCOS women.
Collapse
Affiliation(s)
- Nicia I. Profili
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (N.I.P.); (R.C.); (R.M.); (M.P.); (G.C.)
| | - Roberto Castelli
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (N.I.P.); (R.C.); (R.M.); (M.P.); (G.C.)
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, 20122 Milan, Italy;
| | - Roberto Manetti
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (N.I.P.); (R.C.); (R.M.); (M.P.); (G.C.)
| | - Margherita Maioli
- Department of Biochemical Science, University of Sassari, 07100 Sassari, Italy;
| | - Marco Petrillo
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (N.I.P.); (R.C.); (R.M.); (M.P.); (G.C.)
| | - Giampiero Capobianco
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (N.I.P.); (R.C.); (R.M.); (M.P.); (G.C.)
| | - Alessandro P. Delitala
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (N.I.P.); (R.C.); (R.M.); (M.P.); (G.C.)
| |
Collapse
|
2
|
Cífková R, Strilchuk L. Sex differences in hypertension. Do we need a sex-specific guideline? Front Cardiovasc Med 2022; 9:960336. [PMID: 36082119 PMCID: PMC9445242 DOI: 10.3389/fcvm.2022.960336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/03/2022] [Indexed: 01/02/2023] Open
Abstract
Hypertension is the most prevalent cardiovascular disorder and the leading cause of death worldwide in both sexes. The prevalence of hypertension is lower in premenopausal women than in men of the same age, but sharply increases after the menopause, resulting in higher rates in women aged 65 and older. Awareness, treatment, and control of hypertension are better in women. A sex-pooled analysis from 4 community-based cohort studies found increasing cardiovascular risk beginning at lower systolic blood pressure thresholds for women than men. Hormonal changes after the menopause play a substantial role in the pathophysiology of hypertension in postmenopausal women. Female-specific causes of hypertension such as the use of contraceptive agents and assisted reproductive technologies have been identified. Hypertensive disorders in pregnancy are associated with increased risk of maternal, fetal, and neonatal morbidity and mortality, as well as with a greater risk of developing cardiovascular disease later in life. Hypertension-mediated organ damage was found to be more prevalent in women, thus increasing the cardiovascular risk. Sex differences in pharmacokinetics have been observed, but their clinical implications are still a matter of debate. There are currently no sufficient data to support sex-based differences in the efficacy of antihypertensive treatment. Adverse drug reactions are more frequently reported in women. Women are still underrepresented in large clinical trials in hypertension, and not all of them report sex-specific results. Therefore, it is of utmost importance to oblige scientists to include women in clinical trials and to consider sex as a biological variable.
Collapse
Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital, Prague, Czechia
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
- *Correspondence: Renata Cífková
| | - Larysa Strilchuk
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital, Prague, Czechia
- Department of Therapy No 1, Medical Diagnostics, Hematology and Transfusiology, Lviv Danylo Halytsky National Medical University, Lviv, Ukraine
| |
Collapse
|
3
|
Yu H, Liang Z, Cai R, Jin S, Xia T, Wang C, Kuang Y. Association of adverse birth outcomes with in vitro fertilization after controlling infertility factors based on a singleton live birth cohort. Sci Rep 2022; 12:4528. [PMID: 35296798 PMCID: PMC8927480 DOI: 10.1038/s41598-022-08707-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/11/2022] [Indexed: 11/09/2022] Open
Abstract
Infants conceived with in vitro fertilization (IVF) are exposed to underlying infertility and the IVF process. High risks of adverse birth outcomes (ABOs) were observed among these infants, including preterm birth, low birth weight, macrosomia, being large/small for gestational age (LGA/SGA). It is unclear whether the specific etiology of the rise of ABOs among IVF infants is IVF technology itself or underlying infertility. A total of 9,480 singletons conceived with IVF and 1,952,419 singletons from the general population were obtained in this study. Multivariable logistic regression model was used to assess variations in risk of ABOs according to causes of infertility. Poisson distributions were applied to calculate standardized risk ratios of IVF infants vs. general population after controlling the causes of infertility. Higher risk of preterm birth and low birth weight were observed among parents with polycystic ovary syndrome, endometriosis, uterine and semen abnormalities. Compared to the general population, after excluding the influence of infertility causes, singletons conceived with IVF were at higher risk of macrosomia (SRR = 1.28, 95% CI 1.14-1.44) and LGA (SRR = 1.25, 95% CI 1.15-1.35). The higher risk of ABOs in IVF was driven by both IVF treatments and infertility, which is important for improving IVF treatments and the managing pregnancies and child development.
Collapse
Affiliation(s)
- Huiting Yu
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, People's Republic of China.,School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Zhou Liang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, People's Republic of China
| | - Renzhi Cai
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, People's Republic of China
| | - Shan Jin
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, People's Republic of China
| | - Tian Xia
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, People's Republic of China.
| | - Chunfang Wang
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, People's Republic of China.
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road No. 639, Shanghai, 200011, People's Republic of China.
| |
Collapse
|
4
|
Farrukh F, Abbasi A, Jawed M, Almas A, Jafar T, Virani SS, Samad Z. Hypertension in Women: A South-Asian Perspective. Front Cardiovasc Med 2022; 9:880374. [PMID: 36035921 PMCID: PMC9399392 DOI: 10.3389/fcvm.2022.880374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Hypertension is an important contributor to cardiovascular disease related morbidity and mortality. Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in both men and women. Materials and Methods Numerous databases, i.e., PubMed, ScienceDirect, etc., were searched using keywords to identify relevant studies to our narrative review. The findings from the most pertinent articles were summarized and integrated into our narrative review on hypertension in women. Results The pathophysiology of essential hypertension is still being delineated in both men and women; there are multiple sex specific factors in association with the development of hypertension in women, including age, combined oral contraceptives (COCs), polycystic ovarian syndrome (PCOS), preeclampsia, etc. There are several sex specific considerations in antihypertensives drug choices. Discussion Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in women. Medical treatment and adherence is uniquely challenging for South Asian women due to a variety of socio-cultural-economic factors. Further research is warranted to identify optimal sex-specific treatment options that will improve the control of hypertension and decrease the risk of subsequent cardiovascular disease in both genders.
Collapse
Affiliation(s)
| | - Amin Abbasi
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Misbah Jawed
- Medical College, Ziauddin University, Karachi, Pakistan
| | - Aysha Almas
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Tazeen Jafar
- Medical College, Aga Khan University, Karachi, Pakistan.,Baylor College of Medicine, Houston, TX, United States
| | | | - Zainab Samad
- Medical College, Aga Khan University, Karachi, Pakistan.,Department of Medicine, Duke University, Durham, NC, United States
| |
Collapse
|
5
|
Mills G, Badeghiesh A, Suarthana E, Baghlaf H, Dahan MH. Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies. Hum Reprod 2021; 35:1666-1674. [PMID: 32535629 DOI: 10.1093/humrep/deaa099] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION Does polycystic ovary syndrome (PCOS) confer an independent risk for the development of gestational diabetes mellitus (GDM), gestational hypertension (GHTN) and preeclampsia (PEC) based on analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. SUMMARY ANSWER After controlling for all potential confounding effects, women with PCOS are at a 2-fold higher risk of developing GDM, a 50% increased risk for the development of GHTN and a 30% increased risk of developing PEC than women without PCOS. WHAT IS KNOWN ALREADY Currently, there is evidence of an increased prevalence of maternal pregnancy complications in women with PCOS. However, there remain significant gaps in understanding how PCOS affects the development of GDM, GHTN and PEC. This is most likely due to the complex, multifactorial etiology of PCOS, its range of potential confounders for pregnancy complications and the variable methodology of studies that have been conducted. To date, the largest meta-analysis on this subject includes 11 565 women with PCOS analyzed for their risk of GDM and 5896 patients analyzed for their risk of PEC. STUDY DESIGN, SIZE, DURATION This is a retrospective population-based study utilizing data from the HCUP-NIS over 11 years from 2004 to 2014. A dataset of all deliveries between 2004 and 2014 inclusively was created. Within this group, all deliveries to women with PCOS were identified as part of the study group (n = 14 882), and the remaining deliveries were categorized as non-PCOS births and comprised the reference group (n = 9 081 906). PARTICIPANTS/MATERIALS, SETTING, METHODS The HCUP-NIS is the largest inpatient sample database in the USA and is comprised of hospital inpatient stays submitted by hospitals throughout the entire country. Each year, the database provides information relating to 7 million inpatient stays, including patient characteristics, diagnosis and procedures. The data are representative of ∼20% of admissions to US hospitals across 48 states and the District of Columbia. MAIN RESULTS AND THE ROLE OF CHANCE At baseline, more pregnant women with PCOS were obese (22.3% vs. 3.5%, P < 0.001), had chronic hypertension (HTN) (8.4% vs. 1.8%, P < 0.001), had pregestational diabetes (4.1% vs. 0.9%, P < 0.001) and had treated thyroid disease (12.6% vs. 2.4%, P < 0.001). Women with PCOS were also more likely to have undergone IVF treatment (2.4% vs. 0.1%, P < 0.001), have multi-gestation pregnancies (5.9% vs. 1.5%, P < 0.001), and more multiple gestations (MGs) in the PCOS group were the result of IVF treatment than the non-PCOS groups (12.3% vs. 2.3%, P < 0.001). In all pregnancies, women with PCOS were more likely to develop gestational diabetes (adjusted odds ratio (aOR) 2.19, 95% CI 2.02-2.37), pregnancy associated HTN (aOR 1.38, 95% CI 1.27-1.50, P < 0.001), GHTN (aOR 1.47, 95% CI 1.31-1.64), PEC (aOR 1.29, 95% CI 1.14-1.45) and superimposed PEC (aOR 1.29, 95% CI 1.04-1.59) after controlling for confounding effects (age, race, income level, insurance type, obesity, IVF use, previous cesarean section, chronic HTN, pregestational diabetes, thyroid disease, MG, smoking and recreational drug use). Odds ratios were comparable between all pregnancies and singleton pregnancies only. In women pregnant with multiple fetuses, PCOS only conferred a statistically significant increased risk of developing GDM (aOR 2.33, 95% CI 1.92-2.83, P < 0.001). However, there was a trend toward an increased risk for developing pregnancy associated HTN (aOR 1.92, 95% CI 0.99-1.42, P = 0.058). LIMITATIONS, REASONS FOR CAUTION This is a retrospective analysis utilizing an administrative database which relies on the accuracy and consistency of the individuals coding the data. There are known limitations in how accurately hospital coding is able to capture perinatal conditions and complications, making it difficult to know with certainty that such events are accurate. WIDER IMPLICATIONS OF THE FINDINGS Pregnant women with PCOS are at increased risk of adverse complications in pregnancy even when they do not present with other coexisting metabolic conditions. Furthermore, it is important to also consider the risk of all other coexisting metabolic conditions frequently encountered in PCOS women, as these risks are additive and place women with PCOS at significantly increased risk for adverse complications in pregnancy. STUDY FUNDING/COMPETING INTEREST(S) None.
Collapse
Affiliation(s)
- Ginevra Mills
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Haitham Baghlaf
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
6
|
Zhou S, Ji Y, Wang H. The risk factors of gestational hypertension in patients with polycystic ovary syndrome: a retrospective analysis. BMC Pregnancy Childbirth 2021; 21:336. [PMID: 33906610 PMCID: PMC8080329 DOI: 10.1186/s12884-021-03808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The hypertensive disorders complicating pregnancy (HDCP) is common in patients with polycystic ovary syndrome (PCOS), yet the potential influencing factors remained unclear. We aimed to assess the independent risk factors of HDCP in patients with PCOS, to provide clinical evidences for the management of PCOS. METHODS Pregnant PCOS patients treated in our hospital from June 1, 2018 to November 30, 2020 were approached. The personal and clinical characteristics of patients with and without gestational hypertension were evaluated. Logistic regressions were conducted to identify the independent risk factors of HDCP, Receiver operating characteristics (ROC)curve analysis was conducted to evaluate the predicting value. RESULTS A total of 188 PCOS patients were included, the incidence of HDCP in patients with PCOS was 27.66 %. There were significant differences in the age, BMI, family history of hypertension, the history of adverse pregnancy, history of contraceptive pills use and family history of HDCP between HDCP group and no-HDCP group (all p < 0.05), and there were no significant differences in the family history of diabetes, multiple pregnancy and long-term smoking history between HDCP group and no-HDCP group (all p > 0.05). Age ≥ 27y(OR2.048, 95 %CI1.121 ~ 3.208), BMI ≥ 24 kg/m2(OR1.463, 95 %CI1.069 ~ 2.011), family history of hypertension(OR2.129, 95 %CI1.093 ~ 3.042), the history of adverse pregnancy(OR2.435, 95 %CI1.264 ~ 4.085), history of contraceptive pills use(OR3.806, 95 %CI1.184 ~ 6.102), family history of HDCP(OR1.934, 95 %CI1.016 ~ 2.774) were the independent risk factors of HDCP in patients with PCOS (all p < 0.05). ROC curve analyses indicated that those factors had good predictive value on HDCP in PCOS patients. CONCLUSIONS The incidence of HDCP in PCOS patients is relatively high. In clinical practice, medical workers should carry out early prevention and intervention measures for these risk factors to reduce the incidence of HDCP.
Collapse
Affiliation(s)
- Shu Zhou
- Department of gynaecology, The 5th Affiliated Hospital of Nantong University (Taizhou People's Hospital), Taizhou, China
| | - Yiping Ji
- Department of gynaecology, Lian Shui county People's Hospital, Huai'an, China.
| | - Haimei Wang
- Department of Urology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, No.62, Huaihai Road, Jiangsu, 223002, Huai'an, China.
| |
Collapse
|
7
|
Rantakallio JSS, Nevalainen JE, West SI, Ollila MM, Puukka K, Bloigu AH, Järvelin MR, Tapanainen JS, Franks S, Dunkel L, Piltonen TT, Vääräsmäki MS, Morin-Papunen LC. Association of Self-Reported Polycystic Ovary Syndrome, Obesity, and Weight Gain From Adolescence to Adulthood With Hypertensive Disorders of Pregnancy: A Community-Based Approach. Hypertension 2021; 77:1010-1019. [PMID: 33517680 DOI: 10.1161/hypertensionaha.120.15702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this prospective, population-based cohort study was to evaluate the roles of polycystic ovary syndrome (PCOS), obesity, weight gain, and hyperandrogenemia in the development of hypertensive disorders of pregnancy (HDP) through fertile age both in PCOS and in non-PCOS women. The study population-NFBC1966 (Northern Finland Birth Cohort 1966)-allowed a long-term follow-up of women from age 14 until 46 years who developed HDP (n=408) or did not (n=3373). HDP diagnosis was confirmed by combining hospital discharge records, data from Finnish Medical Birth Registers, and the questionnaire data at age 46. Women with self-reported PCOS (srPCOS; n=279), defined by both oligo-amenorrhea and hirsutism at age 31 or with PCOS diagnosis by age 46, were compared with women without reported PCOS (n=1577). Women with srPCOS had an increased HDP risk (odds ratio, 1.56 [95% CI, 1.03-2.37]), but the association disappeared after adjustment for body mass index. In women with srPCOS and HDP, body mass index increased from age 14 to 46 significantly more than in srPCOS women without HDP (median [interquartile range], 9.82 [6.23-14.6] and 7.21 [4.16-10.5] kg/m2, respectively; P<0.001). Also, in non-PCOS women, the increase was higher in women with (7.54 [5.32-11.62] kg/m2; P<0.001) than without HDP (6.33 [3.90-9.33] kg/m2; P<0.001). Increase in waist circumference between ages 31 and 46 years was associated with HDP but not with PCOS. Hyperandrogenemia at 31 or 46 years did not associate with HDP (1.44 [0.98-2.11]). In conclusion, obesity, especially abdominal obesity, and weight gain from adolescence to age 46, but not srPCOS or hyperandrogenemia, were associated with an increased risk of HDP.
Collapse
Affiliation(s)
- Juhani S S Rantakallio
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Jaana E Nevalainen
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Sammeli I West
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Meri-Maija Ollila
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Katri Puukka
- NordLab Oulu, Department of Clinical Chemistry (K.P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Aini H Bloigu
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Marjo-Riitta Järvelin
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health (M.-R.J.), Imperial College London, United Kingdom
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland (M.-R.J.)
| | - Juha S Tapanainen
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland (J.S.T.)
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology (S.F.), Imperial College London, United Kingdom
| | - Leo Dunkel
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London Medical School, United Kingdom (L.D.)
| | | | - Marja S Vääräsmäki
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Laure C Morin-Papunen
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Nielsen JH, Birukov A, Jensen RC, Kyhl HB, Jørgensen JS, Andersen MS, Glintborg D. Blood pressure and hypertension during pregnancy in women with polycystic ovary syndrome: Odense Child Cohort. Acta Obstet Gynecol Scand 2020; 99:1354-1363. [DOI: 10.1111/aogs.13914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Julie Hougård Nielsen
- Department of Endocrinology and Metabolism Odense University Hospital Odense Denmark
| | - Anna Birukov
- Charité – Universitätsmedizin BerlinCorporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Department of Gynecology and Obstetrics Odense University Hospital Odense Denmark
- Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité‐Universitätsmedizin Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK) Berlin Germany
- Department of Molecular Epidemiology German Institute of Human Nutrition Potsdam‐Rehbrücke Nuthetal Germany
| | - Richard Christian Jensen
- Department of Endocrinology and Metabolism Odense University Hospital Odense Denmark
- Department of Environmental Medicine University of Southern Denmark Odense Denmark
| | - Henriette Boye Kyhl
- Odense Child Cohort Hans Christian Andersen Children’s HospitalOdense University Hospital Odense Denmark
- OPEN Patient data Explorative Network (OPEN) University of Southern Denmark Odense Denmark
| | - Jan Stener Jørgensen
- Department of Gynecology and Obstetrics Odense University Hospital Odense Denmark
| | | | - Dorte Glintborg
- Department of Endocrinology and Metabolism Odense University Hospital Odense Denmark
| |
Collapse
|
10
|
Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019; 3:CD007506. [PMID: 30921477 PMCID: PMC6438659 DOI: 10.1002/14651858.cd007506.pub4] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) affects 8% to 13% of reproductive-aged women and is associated with reproductive and metabolic dysfunction. Obesity worsens the presentation of PCOS and weight management (weight loss, maintenance or prevention of excess weight gain) is proposed as an initial treatment strategy, best achieved through lifestyle changes incorporating diet, exercise and behavioural interventions. OBJECTIVES To assess the effectiveness of lifestyle treatment in improving reproductive, anthropometric (weight and body composition), metabolic and quality of life factors in PCOS. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL and AMED (date of last search March 2018). We also searched controlled trials registries, conference abstracts, relevant journals, reference lists of relevant papers and reviews, and grey literature databases, with no language restrictions applied. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing lifestyle treatment (diet, exercise, behavioural or combined treatments) to minimal or no treatment in women with PCOS. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, assessed evidence quality and risk of bias, and extracted data. Our primary outcomes were live birth, miscarriage and pregnancy. We used inverse variance and fixed-effect models in the meta-analyses. We reported dichotomous outcomes as an odds ratio and continuous outcomes as a mean difference (MD) or standardised mean difference (SMD). MAIN RESULTS We included 15 studies with 498 participants. Ten studies compared physical activity to minimal dietary and behavioural intervention or no intervention. Five studies compared combined dietary, exercise and behavioural intervention to minimal intervention. One study compared behavioural intervention to minimal intervention. Risk of bias varied: eight studies had adequate sequence generation, seven had adequate clinician or outcome assessor blinding, seven had adequate allocation concealment, six had complete outcome data and six were free of selective reporting. No studies assessed the fertility primary outcomes of live birth or miscarriage. No studies reported the secondary reproductive outcome of menstrual regularity, as defined in this review.Lifestyle intervention may improve a secondary (endocrine) reproductive outcome, the free androgen index (FAI) (MD -1.11, 95% confidence interval (CI) -1.96 to -0.26, 6 RCTs, N = 204, I2 = 71%, low-quality evidence). Lifestyle intervention may reduce weight (kg) (MD -1.68 kg, 95% CI -2.66 to -0.70, 9 RCTs, N = 353, I2 = 47%, low-quality evidence). Lifestyle intervention may reduce body mass index (BMI) (kg/m2) (-0.34 kg/m2, 95% CI -0.68 to -0.01, 12 RCTs, N = 434, I2= 0%, low-quality evidence). We are uncertain of the effect of lifestyle intervention on glucose tolerance (glucose outcomes in oral glucose tolerance test) (mmol/L/minute) (SMD -0.02, 95% CI -0.38 to 0.33, 3 RCTs, N = 121, I2 = 0%, low-quality evidence). AUTHORS' CONCLUSIONS Lifestyle intervention may improve the free androgen index (FAI), weight and BMI in women with PCOS. We are uncertain of the effect of lifestyle intervention on glucose tolerance. There were no studies that looked at the effect of lifestyle intervention on live birth, miscarriage or menstrual regularity. Most studies in this review were of low quality mainly due to high or unclear risk of bias across most domains and high heterogeneity for the FAI outcome.
Collapse
Affiliation(s)
- Siew S Lim
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
| | - Samantha K Hutchison
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
- Monash HealthDiabetes Unit and Endocrinology Unit246 Clayton RoadClaytonVictoriaAustralia3168
| | - Emer Van Ryswyk
- College of Medicine and Public Health, Flinders UniversityAdelaide Institute for Sleep Health: A Flinders Centre for Research ExcellenceSturt RoadAdelaideSouth AustraliaAustralia5042
| | - Robert J Norman
- University of AdelaideObstetrics & Gynaecology, Robinson InstituteAdelaideSouth AustraliaAustralia5005
- Fertility SAAdelaideAustralia
| | - Helena J Teede
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
| | - Lisa J Moran
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
| | | |
Collapse
|
11
|
Effect of orlistat on obese women with polycystic ovary syndrome. JOURNAL OF BIO-X RESEARCH 2018. [DOI: 10.1097/jbr.0000000000000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
12
|
Kumar S, Gordon GH, Abbott DH, Mishra JS. Androgens in maternal vascular and placental function: implications for preeclampsia pathogenesis. Reproduction 2018; 156:R155-R167. [PMID: 30325182 PMCID: PMC6198264 DOI: 10.1530/rep-18-0278] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Adequate maternal vascular adaptations and blood supply to the uterus and placenta are crucial for optimal oxygen and nutrient transport to growing fetuses of eutherian mammals, including humans. Multiple factors contribute to hemodynamics and structuring of placental vasculature essential for term pregnancy with minimal complications. In women, failure to achieve or sustain favorable pregnancy progression is, not surprisingly, associated with high incidence of antenatal complications, including preeclampsia, a hypertensive disorder of pregnancy. While the pathogenesis of preeclampsia in women remains unknown, a role for androgens is emerging. The relationship between androgens and maternal cardiovascular and placental function deserves particular consideration because testosterone levels in the circulation of preeclamptic women are elevated approximately two- to three-fold and are positively correlated with vascular dysfunction. Preeclampsia is also associated with elevated placental androgen receptor (AR) gene expression. Studies in animal models mimicking the pattern and level of increase of adult female testosterone levels to those found in preeclamptic pregnancies, replicate key features of preeclampsia, including gestational hypertension, endothelial dysfunction, exaggerated vasoconstriction to angiotensin II, reduced spiral artery remodeling, placental hypoxia, decreased nutrient transport and fetal growth restriction. Taken together, these data strongly implicate AR-mediated testosterone action as an important pathway contributing to clinical manifestation of preeclampsia. This review critically addresses this hypothesis, taking into consideration both clinical and preclinical data.
Collapse
Affiliation(s)
- Sathish Kumar
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA.,Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.,Endocrinology-Reproductive Physiology Program, University of Wisconsin, Madison, Wisconsin, USA
| | - Geoffrey H Gordon
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - David H Abbott
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.,Endocrinology-Reproductive Physiology Program, University of Wisconsin, Madison, Wisconsin, USA.,Wisconsin National Primate Research Center, University of Wisconsin, Madison, Wisconsin, USA
| | - Jay S Mishra
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
| |
Collapse
|