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Vine D, Ghosh M, Wang T, Bakal J. Increased Prevalence of Adverse Health Outcomes Across the Lifespan in Those Affected by Polycystic Ovary Syndrome: A Canadian Population Cohort. CJC Open 2024; 6:314-326. [PMID: 38487056 PMCID: PMC10935704 DOI: 10.1016/j.cjco.2023.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/11/2023] [Indexed: 03/17/2024] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is the most common metabolic-endocrine disorder impacting the health and quality of life of women over the lifespan. Evidence-based data on the scope of adverse health outcomes in those affected by PCOS is critical to improve healthcare and quality of life in this population. The aim of this study was to determine the prevalence of adverse health outcomes in those with PCOS compared to age-matched controls. Methods We conducted a retrospective observational case-control study in those diagnosed with PCOS and age-matched controls using the Alberta Health Services Health Analytics database and the International Classification of Diseases, for the period from 2002-2018 in Alberta, Canada. Results The cohort consisted of n = 16,531 exposed PCOS cases and n = 49,335 age-matched un-exposed controls. The prevalences of hypertension, renal disease, gastrointestinal disease, eating disorders, mental illness, depression-anxiety, rheumatoid arthritis, respiratory infections, and all malignancies were 20%-40% (P < 0.0001) higher in those with PCOS, compared to controls. The prevalence of obesity, dyslipidemia, nonalcoholic fatty liver disease, and type 2 diabetes was 2-3 fold higher in those with PCOS (P < 0.001). Cardiovascular, cerebrovascular, and peripheral vascular disease were 30%-50% higher, and they occurred 3-4 years earlier in those with PCOS (P < 0.0001); a 2-fold higher prevalence of dementia occurred in those with PCOS, compared to controls. Conclusion These findings provide evidence that PCOS is associated with a higher prevalence of morbidities over the lifespan, and the potential scope of the healthcare burden in women affected by PCOS.
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Affiliation(s)
- Donna Vine
- Metabolic and Cardiovascular Disease Laboratory, University of Alberta, Edmonton, Alberta, Canada
| | - Mahua Ghosh
- Division of Endocrinology and Metabolism, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ting Wang
- Alberta Strategy for Patient Orientated Research, Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jeffrey Bakal
- Alberta Strategy for Patient Orientated Research, Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
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Huffman AM, Rezq S, Basnet J, Romero DG. Biomarkers in Polycystic Ovary Syndrome. CURRENT OPINION IN PHYSIOLOGY 2023; 36:100717. [PMID: 37842179 PMCID: PMC10569288 DOI: 10.1016/j.cophys.2023.100717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. PCOS is diagnosed by the presence of two of the following three characteristics: hyperandrogenemia and/or hyperandrogenism, oligo/amenorrhea, and polycystic ovarian morphology. PCOS is associated with reproductive and non-reproductive complications, including obesity, insulin resistance and diabetes, dyslipidemia, and increased blood pressure. There is an urgent need for biomarkers that address both the reproductive and non-reproductive aspects of this complex syndrome. This review focuses on biomarkers, or potential ones, associated with the reproductive and non-reproductive aspects of PCOS, including anthropometric and clinical biomarkers, insulin and the IGF-1 system, lipids, anti-Müllerian hormone and gonadotropins, steroids, inflammatory and renal injury biomarkers, oxidative stress, and non-coding RNAs. We expect that this review will bring some light on the recent updates in the field and encourage researchers to join the exciting and promising field of PCOS biomarkers.
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Affiliation(s)
- Alexandra M. Huffman
- Department of Cell and Molecular Biology, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Mississippi Center of Excellence in Perinatal Research, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Women’s Health Research Center, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Samar Rezq
- Department of Cell and Molecular Biology, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Mississippi Center of Excellence in Perinatal Research, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Women’s Health Research Center, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Jelina Basnet
- Department of Cell and Molecular Biology, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Mississippi Center of Excellence in Perinatal Research, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Women’s Health Research Center, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Damian G. Romero
- Department of Cell and Molecular Biology, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Mississippi Center of Excellence in Perinatal Research, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Women’s Health Research Center, Jackson, Mississippi, USA, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Navarese EP, Vine D, Proctor S, Grzelakowska K, Berti S, Kubica J, Raggi P. Independent Causal Effect of Remnant Cholesterol on Atherosclerotic Cardiovascular Outcomes: A Mendelian Randomization Study. Arterioscler Thromb Vasc Biol 2023; 43:e373-e380. [PMID: 37439258 DOI: 10.1161/atvbaha.123.319297] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Observational studies suggested that residual risk of cardiovascular events after LDL (low-density lipoprotein) cholesterol lowering may be linked to remnant cholesterol (RC). We conducted a large-scale Mendelian randomization study to investigate the causal role of RC to predict coronary artery disease (CAD), myocardial infarction (MI), and stroke risk. METHODS We extracted single-nucleotide polymorphisms for RC and LDL from large-scale genome-wide association databases. We estimated the genetic association with outcomes from the CARDIoGRAMplusC4D consortium (Coronary Artery Disease Genome-Wide Replication and Meta-Analysis Plus the Coronary Artery Disease Genetics), the Metastroke consortium, as well as the GLGC (Global Lipids Genetics Consortium). Genetic variants were used as instruments, thereby minimizing residual confounding and reverse causation biases of observational studies. RESULTS By leveraging data from a combined sample of 958 434 participants, we found evidence for a significant causal effect of RC on the risk of CAD (odds ratio [OR], 1.51 per SD unit increase in RC [95% CI, 1.42-1.60]; P=5.3×10-5), MI (OR, 1.57 [95% CI, 1.21-2.05]; P=9.5×10-4), and stroke (OR, 1.23 [95% CI, 1.12-1.35]; P=3.72×10-6). There was no evidence of pleiotropy. The effect of RC on CAD and MI remained consistent after accounting for the effects of RC-associated genetic variants on LDL cholesterol: OR, 1.49 (95% CI, 1.37-1.61) for CAD and OR, 1.80 (95% CI, 1.70-19.1) for MI without a meaningful indirect effect exerted on these outcomes via the LDL cholesterol mediator. CONCLUSIONS This large-scale Mendelian randomization study showed a robust genetic causal association between RC and cardiovascular outcomes. The effect on CAD and MI is independent of LDL cholesterol. Early screening for RC along with long-term inhibition of RC should be the focus of future therapeutic interventions.
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Affiliation(s)
- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland (E.P.N., K.G., J.K.)
- Division of Cardiology and Department of Medicine (E.P.N., P.R.), University of Alberta, Edmonton, Canada
- SIRIO MEDICINE Research Network, Poland (E.P.N., J.K.)
- Now with Clinical and Interventional Cardiology, Sassari University Hospital, Italy (E.P.N.)
| | - Donna Vine
- Metabolic and Cardiovascular Diseases Laboratory (D.V., S.P.), University of Alberta, Edmonton, Canada
| | - Spencer Proctor
- Metabolic and Cardiovascular Diseases Laboratory (D.V., S.P.), University of Alberta, Edmonton, Canada
| | - Klaudyna Grzelakowska
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland (E.P.N., K.G., J.K.)
| | - Sergio Berti
- Cardiology Unit, Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy (S.B.)
| | - Jacek Kubica
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland (E.P.N., K.G., J.K.)
- SIRIO MEDICINE Research Network, Poland (E.P.N., J.K.)
| | - Paolo Raggi
- Division of Cardiology and Department of Medicine (E.P.N., P.R.), University of Alberta, Edmonton, Canada
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HDL-Associated Proteins in Subjects with Polycystic Ovary Syndrome: A Proteomic Study. Cells 2023; 12:cells12060855. [PMID: 36980195 PMCID: PMC10047209 DOI: 10.3390/cells12060855] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction. Serum lipoproteins, with the exception of high-density lipoprotein cholesterol (HDL-C), are increased in polycystic ovary syndrome (PCOS) and their levels may reflect the associated obesity and insulin resistance, but the nature of this association is not fully explained. Therefore, proteomic analysis of key proteins in lipoprotein metabolism was performed. Methods. In this cohort study, plasma was collected from 234 women (137 with PCOS and 97 controls without PCOS). Somalogic proteomic analysis was undertaken for the following 19 proteins involved in lipoprotein, and particularly HDL, metabolism: alpha-1-antichymotrypsin; alpha-1-antitrypsin; apolipoproteins A-1, B, D, E, E2, E3, E4, L1, and M; clusterin; complement C3; hemopexin; heparin cofactor II; kininogen-1; serum amyloid A-1; amyloid beta A-4; and paraoxonase-1. Results. The levels of apolipoprotein E were higher in PCOS (p = 0.012). However, the other isoforms of ApoE, ApoE2, E3, and E4, did not differ when compared with controls. ApoM was lower in PCOS (p = 0.000002). Complement C3 was higher in PCOS (p = 0.037), as was heparin cofactor II (HCFII) (p = 0.0004). The levels of the other proteins associated with lipoprotein metabolism did not differ between PCOS and controls. Conclusions. These data contribute to the concern of the deleterious dyslipidemia found in PCOS, with the novel combination reported here of higher levels of ApoE, C3 and HCFII together with lower ApoM. The dysregulation of these proteins could circumvent the protective effect of HDL-C and contribute to a more atherogenic profile that may increase cardiovascular risk.
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Paola Gutiérrez Castro K, Patricia González A, Caccavello R, Garay-Sevilla ME, Gugliucci A. Lean adolescents with insulin resistance display higher angiopoietin like protein 3, ApoC-III and chylomicron remnant dyslipidemia. Clin Chim Acta 2021; 526:43-48. [PMID: 34971570 DOI: 10.1016/j.cca.2021.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Triglyceride-rich lipoproteins (TRL: chylomicrons and VLDL) are a key component of diabetes dyslipoproteinemia and cardiovascular risk. We have shown that it is already prevalent in obese adolescents in association with lipoprotein lipase (LPL) dysregulation. Insulin resistance (IR) suffices to produce TRL dyslipoproteinemia and LPL dysfunction even in the absence of obesity. METHODS This cross-sectional study included euglycemic adolescents between 15 and 19 y, classified in 4 groups according to BMI, HOMA-IR and fasting lipid as: metabolically healthy lean (MHL, n = 30), metabolically unhealthy lean (MUL, n = 25), metabolically healthy obese (MHO, = 30), and metabolically unhealthy obese (MUO, n = 42). RESULTS As compared to MHL, MUL participants showed 73% higher concentrations of ApoB-48; 84% of ApoC-III; 24% ANGPTL-3; 200% of TG; 218% of VLDL-C and 238% of TG/HDL-C c, No changes were found in LPL mass. Interestingly, the differences in these parameters between MUL and MHO were not significant. CONCLUSION Euglycemic lean adolescents with IR display TRL dyslipoproteinemia with increased inhibition of LPL as highlighted by higher concentrations of ANGPTL-3, ApoC-III and fasting chylomicron remnants (ApoB-48).
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Affiliation(s)
| | - Alma Patricia González
- Department of Medical Science. Division of Health Science. University of Guanajuato. Campus León, Mexico; High Specialty Medical Unit. Hospital of Gynecology and Pediatrics # 48. Mexican Institute of Social Security, Mexico
| | - Russell Caccavello
- Glycation, Oxidation and Disease Laboratory, Dept. of Research, College of Osteopathic Medicine, Touro University California, United States
| | - Ma Eugenia Garay-Sevilla
- Department of Medical Science. Division of Health Science. University of Guanajuato. Campus León, Mexico
| | - Alejandro Gugliucci
- Glycation, Oxidation and Disease Laboratory, Dept. of Research, College of Osteopathic Medicine, Touro University California, United States.
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Garoufi A, Pagoni A, Papadaki M, Marmarinos A, Karapostolakis G, Michala L, Soldatou A. Cardiovascular Risk Factors and Subclinical Atherosclerosis in Greek Adolescents with Polycystic Ovary Syndrome: Its Relationship with Body Mass Index. CHILDREN 2021; 9:children9010004. [PMID: 35053629 PMCID: PMC8773958 DOI: 10.3390/children9010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine condition affecting 6–18% of adolescents and is strongly associated with obesity and cardiovascular risk factors, enhancing the risk of atherosclerosis. Thirty-two adolescents with newly diagnosed PCOS were evaluated for lipid profile disorders, insulin resistance, inflammation, non-alcoholic fatty liver disease (NAFLD), and subclinical atherosclerosis through measurements of carotid intima–media thickness (cIMT). The relationships of the above markers with increased body mass index and abdominal obesity were investigated. Twenty-three adolescents (72%) were overweight (OW) or obese (OB). The OW/OB group had significantly higher insulin, HOMA-IR, high-sensitive C-reactive protein (hsCRP), visceral adiposity index (VAI), and lipid accumulation product (LAP) levels; and lower glucose-per-insulin ratios and HDL-C levels compared to the healthy weight group. The cIMT and small dense low-density lipoprotein cholesterol (sdLDL-C) levels did not differ between the two groups. Similarly, cIMT and sdLDL-C levels did not differ between PCOS-adolescents and healthy controls. CIMT was positively correlated with systolic blood pressure and waist circumference per height ratio. In conclusion, OW/OB PCOS-adolescents have a cluster of adverse factors predisposing them to atherosclerotic cardiovascular disease. Therefore, early cardiovascular risk assessment, as well as timely and targeted interventions, are necessary for prevention.
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Affiliation(s)
- Anastasia Garoufi
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
| | - Athanasia Pagoni
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
| | - Maria Papadaki
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
| | - Antonios Marmarinos
- Laboratory of Clinical Biochemistry—Molecular Diagnostic, 2nd Department of Pediatrics, Medical School, NKUA, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, Greece;
| | - Georgios Karapostolakis
- Radiology Department, 401 Military General Hospital of Athens (MGHA), 138 Mesogeion Av., 11525 Athens, Greece;
| | - Lina Michala
- First Department of Obstetrics and Gynaecology, Medical School, Alexandra General Hospital, National and Kapodistrian University of Athens (NKUA), 80 Vassilissis Sofias Av., 11528 Athens, Greece;
| | - Alexandra Soldatou
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
- Correspondence:
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Vine D, Proctor E, Weaver O, Ghosh M, Maximova K, Proctor S. A Pilot Trial: Fish Oil and Metformin Effects on ApoB-Remnants and Triglycerides in Women With Polycystic Ovary Syndrome. J Endocr Soc 2021; 5:bvab114. [PMID: 34286169 PMCID: PMC8282216 DOI: 10.1210/jendso/bvab114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Indexed: 01/14/2023] Open
Abstract
CONTEXT Women with polycystic ovary syndrome (PCOS) have increased incidence of atherogenic dyslipidemia and cardiovascular disease (CVD). Interventions targeting atherogenic dyslipidemia to reduce CVD risk are limited in women with PCOS. OBJECTIVE This pilot study was conducted to determine the effect of 12 weeks of high dose fish oil (FO), metformin, and FO as an adjunct to metformin (FO-metformin) therapy on fasting and nonfasting plasma lipids and ApoB-remnants in young women with the metabolic syndrome (MetS) and PCOS. METHODS In this open-label parallel pilot trial, women with MetS and PCOS (18-30 years of age) were randomized into 1 of 3 interventions: (1) FO; (2) metformin; and (3) FO-metformin. Plasma lipids and ApoB (48 and 100)-lipoproteins and triglycerides (TG) were measured in the fasted and postprandial state following a high-fat meal at baseline and postintervention. RESULTS FO-metformin significantly lowered fasting plasma TG by >40% compared with FO and metformin treatments. Fasting plasma apoB48 was lowered 40% in FO-metformin and 15% in the FO groups from baseline to postintervention. ApoB48 area under the curve (ApoB48AUC), ApoB48 incremental AUC (ApoB48iAUC), ApoB100AUC, and ApoB100iAUC decreased in all groups from baseline to postintervention; however, these findings did not reach statistical significance. CONCLUSION The findings of this pilot trial show that high dose FO and FO-metformin combination therapy tend to lower fasting and postprandial plasma TG and ApoB-lipoprotein remnants compared with metformin; however, the study is limited by small sample size. These results may be clinically significant in individuals with PCOS for management of atherogenic dyslipidemia.
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Affiliation(s)
- Donna Vine
- Metabolic and Cardiovascular Diseases Laboratory, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Ethan Proctor
- Metabolic and Cardiovascular Diseases Laboratory, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Olivia Weaver
- Metabolic and Cardiovascular Diseases Laboratory, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mahua Ghosh
- Department of Endocrinology and Metabolism, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Katerina Maximova
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Spencer Proctor
- Metabolic and Cardiovascular Diseases Laboratory, University of Alberta, Edmonton, AB T6G 2R3, Canada
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