Evaluation of early atherosclerotic findings in women with polycystic ovary syndrome

Comprehensive Meta-Analysis of Functional and Structural Markers of Subclinical Atherosclerosis in Women with Polycystic Ovary Syndrome

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.

Metabolic syndrome and the risk of cardiovascular complications in young patients with different phenotypes of polycystic ovary syndrome

PURPOSE

Insulin resistance is an important factor in the pathogenesis of polycystic ovary syndrome (PCOS), which is associated with higher risk of metabolic syndrome (MetS) and cardiovascular complications. Early atherosclerotic lesions may be diagnosed by ultrasonographic parameters: brachial artery flow-mediated dilation after reactive hyperaemia (FMD) and intima-media thickness of common carotid artery (IMT). The aim of the study was to assess the relation of IMT and FMD with clinical and laboratory parameters reflecting metabolic status in young women with different PCOS phenotypes.

METHODS

The study included 154 PCOS patients diagnosed with the Rotterdam criteria, divided into four phenotypes, and 113 healthy women. Laboratory analyses, transvaginal ultrasound, and IMT and FMD measurements were conducted. MetS was diagnosed with International Diabetes Federation/American Heart Association (IDF/AHA) consensus criteria.

RESULTS

MetS was more prevalent in PCOS patients than healthy women (14.29 vs. 5.31%; p = 0.019), with highest prevalence in phenotypes I and II (p = 0.039). IMT and FMD did not differ between PCOS patients and the controls, nor between the PCOS phenotypes. PCOS patients with MetS presented lower FMD than other PCOS patients (p = 0.018). In women with PCOS, FMD correlated with glucose and insulin concentrations in the fasting state (R = -0.33, p = 0.002; R = -0.23, p = 0.026) and at 2 h of OGTT (R = -0.29, p = 0.006; R = -0.26, p = 0.014). In patients with phenotype I, correlations were found between IMT and BMI (R = 0.45, p = 0.006) and between FMD and fasting glucose concentrations (R = -0.46, p = 0.011).

CONCLUSIONS

Metabolic disturbances and the diagnosis of MetS in patients with PCOS, especially in hyperandrogenic phenotypes, might be associated with alterations in IMT and FMD.

Assessment of Early Markers of Cardiovascular Risk in Polycystic Ovary Syndrome

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.

Assessment of Early Markers of Cardiovascular Risk in Polycystic Ovary Syndrome

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Cardiovascular Risk in Postmenopausal Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting women of reproductive age. The hormonal alterations of PCOS have been linked with a higher risk of metabolic disturbances in young, reproductively active women. However, it remains to be clarified whether the presence of PCOS increases the risk of cardiovascular disease (CVD) later in life. Aging ameliorates the clinical manifestations of PCOS; hyperandrogenaemia and metabolic abnormalities, however, persist beyond the menopause. On the other hand, aging and menopause increase CVD risk in the general female population. The results of the limited available studies in aging women with a previous diagnosis of PCOS demonstrate early atherosclerosis. However, studies addressing clinical CVD outcomes in women with PCOS report inconsistent findings. A possible explanation for this heterogeneity is the difficulty in diagnosing PCOS after the menopausal transition, due to the absence of validated diagnostic criteria for this population. Larger prospective studies of women diagnosed during their reproductive years will shed more light on the longer-term CVD implications of PCOS.

Increased fibulin-1 plasma levels in polycystic ovary syndrome (PCOS) patients: possible contribution to the link between PCOS and cardiovascular risk

PURPOSE

To investigate a possible relation between fibulin-1 plasma levels and PCOS.

DESIGN

ELISA quantitative determination of human fibulin-1.

METHODS

50 women with PCOS and 40 control patients who attended the Unit of Human Reproductive Pathophysiology, Università Cattolica del Sacro Cuore, Rome, were enrolled. Ultrasonographic pelvic examinations, hormonal profile assays, oral tolerance test OGTT, lipid profile and ELISA quantitative determination of human fibulin-1 were performed.

RESULTS

Fibulin-1 levels were found to be statistically significantly higher in PCOS patients than in matched control women. No statistically significant positive correlation was found between fibulin-1 and AUCi, HOMA-IR, total cholesterol, LDL, AMH, androstenedione and FAI, whereas a statistically significant positive correlation was found between fibulin-1 and 17OHP (p = 0.016) in the PCOS group. However, multivariable linear regression analysis showed that 17 OH P did not independently predict fibulin-1 levels (p = 0.089).

CONCLUSIONS

Our data could contribute to explain the hypothesized increased cardiovascular risk and vascular damage in patients with PCOS. A better understanding of the cellular and molecular mechanisms involved in cardiometabolic disorders associated with PCOS is mandatory to identify new therapeutic strategies to eventually prevent the progression of cardiovascular diseases in these patients.

The cardiovascular effects of premature ovarian failure

BACKGROUND

Previous studies have shown that cardiovascular risk is increased in premature ovarian failure (POF). To determine the effects of POF on different parameters of cardiovascular health, we investigated the relationship between POF and circulating endothelial progenitor cells (EPC), endothelial function, carotid intima media thickness (CIMT) and left ventricular diastolic function.

METHODS

We compared 23 female POF patients (mean age; 37.8 ± 10.8 years) with 20 gender and age-matched healthy controls. Circulating CD133(+)/34(+) and CD34(+)/KDR(+) EPCs were determined by using flow-cytometry. Ultrasound assessment of endothelial function by brachial artery flow-mediated dilatation (FMD) and CIMT was made. Left ventricular systolic and diastolic function was assessed by standard 2D and M-mode echocardiography and tissue Doppler velocities.

RESULTS

Brachial artery FMD was significantly impaired in patients with POF compared with CG (6.3 ± 1.9% vs 10.4 ± 3.7%, p<0.05). Furthermore, circulating EPCs were lower among patients with POF compared to controls for CD133(+)/34(+) and CD34(+)/KDR(+) cells (p<0.05). There was a significant correlation between serum estradiol levels and EPC number (CD 133+/34+) (r=0.329, p<0.05). POF patients had increased CIMT compared to controls (0.67 ± 0.17 vs 0.43 ± 0.10, p<0.05). When diastolic functions were assessed, patients with POF had lower Epeak, Apeak and mitral CP and higher DT and IVRT (p<0.05, respectively).

CONCLUSION

Our findings indicate that endothelial function as well as circulating EPCs, CIMT and diastolic function are significantly affected in young women with POF which may have an adverse long-term effect on cardiovascular prognosis.