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Sun D, Wu Y, Ding M, Zhu F. Comprehensive Meta-Analysis of Functional and Structural Markers of Subclinical Atherosclerosis in Women with Polycystic Ovary Syndrome. Angiology 2022; 73:622-634. [PMID: 35258380 DOI: 10.1177/00033197211072598] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between polycystic ovary syndrome (PCOS) and subclinical atherosclerosis remains unclear. We performed a comprehensive systematic review and meta-analysis to evaluate the effect of PCOS on functional and structural markers of subclinical atherosclerosis as measured by carotid intima-media thickness (cIMT), flow-mediated vasodilation (FMD), nitroglycerin-mediated vasodilation (NMD), pulse wave velocity (PWV), and coronary artery calcium (CAC). Standard mean differences (SMDs) or odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated. Ninety-six articles involving 5550 PCOS patients and 5974 controls were included. Compared with controls, PCOS patients showed significantly thicker cIMT (SMD (95% CI) = .587 (.398, .776), P < .001), lower FMD (SMD (95% CI) = -.649 (-.946, -.353), P < .001) and NMD (SMD (95% CI) = -.502 (-.686, -.317), P < .001), as well as higher PWV (SMD (95% CI) = .382 (.019, .746), P = .039), and increased CAC incidence (OR (95% CI) = 2.204 (1.687, 2.879), P < .001). When analyzing subgroups by age and body mass index (BMI), results were still significant (P < .05) except for PWV in the BMI subgroup. There was no significant result on sensitivity analysis, and Begg' test or Egger's test. PCOS contributes to subclinical atherosclerosis, resulting in functional and structural changes in cIMT, FMD and NMD, PWV, and CAC incidence.
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Affiliation(s)
- Dandan Sun
- Department of Cardiovascular Ultrasound, 159408The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Yupeng Wu
- Department of Neurosurgery, 159408The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Mingyan Ding
- Department of Cardiovascular Ultrasound, 159408The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Fang Zhu
- Department of Cardiovascular Ultrasound, 159408The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
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Hypertension Predisposition and Thermoregulation Delays in Adolescents with Polycystic Ovary Syndrome: A Pilot Study. CHILDREN 2022; 9:children9030316. [PMID: 35327688 PMCID: PMC8946960 DOI: 10.3390/children9030316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
Background: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder in which clinical, sonographic, and endophenotypic features have been underinvestigated or inconclusive, especially in the early stages of the disease (adolescence/young adulthood). Objective: This prospective pilot study focused on the differences of multiple physiological functions between Greek adolescent/young adult females suffering from PCOS and age- and body mass index (BMI)- matched healthy controls. Study design: Nineteen PCOS patients and eighteen healthy controls (aged 13 to 23 years) were studied for: (i) biochemical and hormonal dysfunction by measuring circulating glucose, insulin, and androgen levels; (ii) arterial stiffness with pulse wave analysis (PWA) by Sphygmocord; (iii) intima-media thickness (IMT) by ultrasound; (iv) heart rate variability (HRV) by Task Force Monitor; and (v) QT, QRS, QT, P, QRSD by electrocardiogram (ECG). Statistical analysis included Hedge’s g correction for small samples bias, and the results are shown using the Hedge’s g effect size and 95% CI, in line with precision medicine prerequisites. Results: Significant differences in pulse wave velocity (PWV) (g = 0.964 [0.296, 1.632]), subendocardial viability ratio (SEVR) carotid (g = −0.679 [−1.329, −0.030]), pulse pressure (PP) carotid (g = 0.942 [0.275, 1.608]), systolic pressure (SP) carotid (g = 0.785 [0.129, 1.440]), free-testosterone (g = 0.677 [0.042, 0.312]), and Delta4-androstenedione (g = 0.735 [0.097, 0.373]) were observed between PCOS patients and controls. No differences were detected in the remaining endocrine and PWA or ECG biomarkers. Conclusions: Our multidisciplinary approach showed early onset of vascular dysfunction, predisposition to hypertension, thermoregulation delays, and metabolic syndrome changes in adolescent/young adult PCOS.
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Alexandraki KI, Kandaraki EA, Poulia KA, Piperi C, Papadimitriou E, Papaioannou TG. Assessment of Early Markers of Cardiovascular Risk in Polycystic Ovary Syndrome. TOUCHREVIEWS IN ENDOCRINOLOGY 2021; 17:37-53. [PMID: 35118445 DOI: 10.17925/ee.2021.17.1.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/22/2020] [Indexed: 11/24/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome, with long-term sequelae from birth to senescence. The long-term effects of PCOS are attributed to several metabolic aberrations ensuing the syndrome. In a systematic review of literature regarding the cardiovascular risk factors that accompany PCOS, we found that macrovascular function has been assessed by flow-mediated dilatation (FMD), microvascular function by venous occlusion plethysmography (VOP), and arterial structure by ultrasonographic assessment of intima-media thickness (IMT) usually of the carotid artery. Contradictory results have been reported; however, in most studies, endothelial dysfunction, an early marker of atherosclerosis assessed either by haemodynamic methods such as FMD or by biochemical methods such as endothelin-1 levels, was found to be impaired. VOP is a less-studied method, with few indices altered. IMT was found to be altered in most of the included studies, but the population was more heterogeneous. Inflammatory markers, including C-reactive protein, were also found to be altered in most studies. On the other hand, a number of interventions have been shown beneficial for the markers of cardiovascular risk, in the context of insulin-sensitizers. However, other interventions such as oral contraceptive pills or statins did not consistently show a similar beneficial effect. In summary, the early identification and eventual treatment of cardiovascular clinical and biochemical risk factors may be used in clinical practice to prevent potential 'silent' triggers of cardiovascular disease.
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Affiliation(s)
- Krystallenia I Alexandraki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleitho Practice, Athens, Greece
| | - Eleni A Kandaraki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Department of Endocrinology & Diabetes Mellitus, HYGEIA Hospital, Athens, Greece
| | | | - Christina Piperi
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Theodoros G Papaioannou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Alexandraki KI, Kandaraki EA, Poulia KA, Piperi C, Papadimitriou E, Papaioannou TG. Assessment of Early Markers of Cardiovascular Risk in Polycystic Ovary Syndrome. EUROPEAN ENDOCRINOLOGY 2021. [DOI: 10.17925/ee.2021.1.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yildir IC, Kutluturk F, Tasliyurt T, Yelken BM, Acu B, Beyhan M, Erkorkmaz U, Yilmaz A. Insulin resistance and cardiovascular risk factors in women with PCOS who have normal glucose tolerance test. Gynecol Endocrinol 2013; 29:148-51. [PMID: 23127112 DOI: 10.3109/09513590.2012.730573] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION We aimed to determine the insulin resistance in women with PCOS patients who have normal oral glucose tolerance test (OGTT) and to evaluate cardiovascular risk by measuring C-reactive protein (CRP) and carotid intimae-media thickness (CIMT). METHODS A total of 34 patients and age and body mass matched 20 healthy control subjects were included to this prospective study. Both of patients and control groups were consisted of normal oral glucose tolerance test. Insulin resistance (IR) was estimated using HOMA-IR method. CRP, lipid and hormone levels were measured. CIMT was measured by Carotid Artery B-Mode ultrasonography. RESULTS There was no significant difference between patients and controls in BMI, and waist circumference, lipid, TSH, LH, FSH, estradiol, and prolactin levels. Serum insulin, testosterone, DHEAS, ferritin levels and HOMA values were significantly higher in patient group. We found that 64.7% (n = 22/34) patients with PCOS had insulin resistance. Both of CIMT and CRP levels were significantly higher in the PCOS patients had BMI over 25 kg/m². CRP levels was significantly higher in the PCOS patients had waist circumference greater than 80 cm. CONCLUSION We found insulin resistance in the women with PCOS even if OGTT was normal. Our data were similar to literature, the women with PCOS have increased risk of premature atherosclerosis and metabolic syndrome.
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Affiliation(s)
- Ismail Cem Yildir
- Department Internal Medicine, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
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Cicero AF, Tartagni E, Ertek S. Metformin and its clinical use: new insights for an old drug in clinical practice. Arch Med Sci 2012; 8:907-17. [PMID: 23185203 PMCID: PMC3506244 DOI: 10.5114/aoms.2012.31622] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/19/2012] [Accepted: 10/28/2012] [Indexed: 01/19/2023] Open
Abstract
Metformin is generally recommended as first-line treatment in type 2 diabetes, especially in overweight patients, but in recent years new indications for its use have emerged. Metformin has been found to be safe and efficacious both as monotherapy and in combination with all oral antidiabetic agents and insulins. If metformin use during pregnancy and the lactation period is supported by few data, it could be indicated for women with polycystic ovary syndrome, since it could diminish circulating androgens and insulin resistance, thus ameliorating the ovulation rate. Metformin seems to reduce cancer risk, which appears to be increased in diabetics, and is a promising agent for oncoprevention and chemotherapy combinations. Moreover, metformin could find a place in the treatment of non-alcoholic fatty liver disease. Lactic acidosis could be decreased by avoiding metformin use in patients with hypovolemia, sepsis, renal impairment, hypoxic respiratory diseases and heart failure, in the preoperative period and before intravenous injection of contrast media.
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Affiliation(s)
| | - Elisa Tartagni
- Medical and Surgical Sciences Department, Bologna University, Italy
| | - Sibel Ertek
- Department of Endocrinology and Metabolic Diseases, Ufuk University, Ankara, Turkey
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Dogan MI, Tasci I, Bulucu F, Aydogdu A, Acar R, Ceyhan T, Koc B, Demir O, Gezer M, Sağlam K. Abdominal Obesity is Associated With a Lower Ankle–Brachial Index in Women With Polycystic Ovary Syndrome. Angiology 2012; 64:105-11. [DOI: 10.1177/0003319711436248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ilker Tasci
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Fatih Bulucu
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Aydogan Aydogdu
- Department of Endocrinology and Metabolism, Gulhane School of Medicine, Ankara, Turkey
| | - Ramazan Acar
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Temel Ceyhan
- Department of Obstetrics and Gynecology, Gulhane School of Medicine, Ankara, Turkey
| | - Bayram Koc
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Orhan Demir
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Mustafa Gezer
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Kenan Sağlam
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
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