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Shah AK, Yadav BK, Suri A, Shah AK. A study on lipoprotein-a and PAI-1 in women with polycystic ovary syndrome. Horm Mol Biol Clin Investig 2022; 43:357-361. [PMID: 35439403 DOI: 10.1515/hmbci-2021-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/19/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES PCOS is the most common endocrinological disorder amongst women of reproductive age. The consequences of PCOS extend beyond the reproductive axis and may lead to the development of metabolic syndrome leading to a high risk for hypertension and cardiovascular disease. Therefore, a more comprehensive evaluation of biochemical markers that reflect the cardiovascular risk is required for further understanding of pathophysiologic mechanisms, diagnosis and management. METHODS In this case-control study, women diagnosed with PCOS (n=100) in the age group (18-35 years) years were taken as cases and age matched healthy controls (n=100) were enrolled. Estimations of fasting plasma Glucose, serum total cholesterol (TC), triglycerides (TG) and High-density lipoprotein (HDL) concentrations were assayed while Low-density lipoprotein (LDL) was calculated by using Fredrickson Friedwald's formula. Serum Lipoprotein-a (Lp-a) was estimated using ELISA (Enzyme Linked Immunosorbent Assay). The quantitative data were expressed as Mean ± Standard Deviation (SD). Unpaired Student's t-test was used to compare the values (PCOS vs Controls) and Pearson's correlation coefficient was used to elucidate the relationship between the variables. RESULTS FBS and all lipid parameters were significantly increased in PCOS patients compared to control subjects. On the other hand, HDL-C was significantly decreased as compared to the control subjects. The hormones TSH, LH, FSH, PRL and LH/FSH ratio were significantly increased in PCOS patients compared to control subjects. Lipoprotein-a and PAI-1 was significantly increased in PCOS patients compared to the control subjects. Upon bivariate correlation analysis, Lp(a) had significant correlations with PAI-1 (r=0.35, p=0.000), WHR (r=0.25, p=0.000), LDL (r=0.52, p=0.000) and TSH (r=0.24, p=0.000). While the correlations with FBS (r=-0.008, p=0.91) and LH/FSH ratio (r=-0.004, p=0.95) were statistically insignificant. CONCLUSIONS The evaluation of serum biomarkers such as Lp-a, PAI-1 and lipid profile routinely in PCOS patients may have diagnostic role in the early detection of metabolic abnormalities and endocrine derangements and timely management of comorbid Diabetes and Cardiovascular disease in PCOS females.
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Affiliation(s)
- Ashok Kumar Shah
- Department of Biochemistry, Adesh Medical College and Hospital, Shahbad (M), Haryana, India
| | - Birendra Kumar Yadav
- Department of Biochemistry, Banas Medical College and Research Institute, Palanpur, Gujrat, India
| | - Arpita Suri
- Department of Biochemistry, SGT Medical College, Hospital and Research Institute, Gurgaon, Haryana, India
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Nikanfar S, Oghbaei H, Rastgar Rezaei Y, Zarezadeh R, Jafari-Gharabaghlou D, Nejabati HR, Bahrami Z, Bleisinger N, Samadi N, Fattahi A, Nouri M, Dittrich R. Role of adipokines in the ovarian function: Oogenesis and steroidogenesis. J Steroid Biochem Mol Biol 2021; 209:105852. [PMID: 33610800 DOI: 10.1016/j.jsbmb.2021.105852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/28/2020] [Accepted: 01/30/2021] [Indexed: 01/02/2023]
Abstract
Adipokines are mainly produced by adipose tissue; however, their expression has been reported in other organs including female reproductive tissues. Therefore, adipokines have opened new avenues of research in female fertility. In this regard, studies reported different roles for certain adipokines in ovarian function, although the role of other recently identified adipokines is still controversial. It seems that adipokines are essential for normal ovarian function and their abnormal levels could be associated with ovarian-related disorders. The objective of this study is to review the available information regarding the role of adipokines in ovarian functions including follicular development, oogenesis and steroidogenesis and also their involvement in ovary-related disorders.
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Affiliation(s)
- Saba Nikanfar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hajar Oghbaei
- Department of Physiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yeganeh Rastgar Rezaei
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Zarezadeh
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Davoud Jafari-Gharabaghlou
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Reza Nejabati
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Bahrami
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nathalie Bleisinger
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen, Nürnberg, Erlangen, Germany
| | - Naser Samadi
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen, Nürnberg, Erlangen, Germany; Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Nouri
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen, Nürnberg, Erlangen, Germany
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Chen B, Chang HM, Zhang Z, Cao Y, Leung PCK. ALK4-SMAD3/4 mediates the effects of activin A on the upregulation of PAI-1 in human granulosa lutein cells. Mol Cell Endocrinol 2020; 505:110731. [PMID: 31982478 DOI: 10.1016/j.mce.2020.110731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/03/2020] [Accepted: 01/20/2020] [Indexed: 12/26/2022]
Abstract
In the mammalian ovary, the proteolysis of the extracellular matrix is dynamically regulated by plasminogen activator and plasminogen activator inhibitor (PAI), and it is a critical event that influences various physiological and pathological processes. Activin A is a member of the transforming growth factor-β superfamily and is expressed at a high level in human luteal cells that play an essential role in the regulation of the luteal function. At present, it is not known whether activin A can regulate the expression and production of PAI in human granulosa lutein (hGL) cells. The present study aimed to examine the effects of activin A on the expression and production of intraovarian PAI-1 and the underlying molecular mechanisms. Using primary and immortalized hGL cells as the cell model, we demonstrated that activin A upregulated the expression of PAI-1 and increased the production of PAI-1 in an autocrine/paracrine manner. Additionally, using a dual inhibition approach (molecular inhibitors and siRNA-mediated knockdown), we showed that this biological function is mediated by the ALK4-mediated SMAD3-SMAD4-dependent signaling pathway. Our findings suggest that activin A may be involved in the regulation of luteal function via the induction of PAI-1 expression and an increase in PAI-1 production.
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Affiliation(s)
- Beili Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China; Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hsun-Ming Chang
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zhiguo Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Peter C K Leung
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
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Godtfredsen ACM, Sidelmann JJ, Gram JB, Andersen M, Glintborg D. Fibrin lysability is associated with central obesity and inflammation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2020; 99:1078-1084. [PMID: 32048272 DOI: 10.1111/aogs.13825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is characterized by increased central fat mass (CFM), hyper-inflammation, and hemostatic alterations; the risk of cardiovascular disease may also be increased. Reduced fibrin lysability is a risk factor for cardiovascular disease. The present study assessed fibrin lysability in women with PCOS and controls of similar age and body mass index. MATERIAL AND METHODS Ninety women with PCOS and 35 controls of comparable age and body mass index were included. Hemostatic markers (fibrin lysability, fibrinogen, coagulation factor XIII, plasminogen, plasminogen activator inhibitor 1 [PAI-1], plasmin inhibitor, thrombin activatable fibrinolysis inhibitor (TAFI), D-dimer), C-reactive protein (CRP), body mass index, waist-to-hip ratio, CFM determined by Dual-energy X-ray absorptiometry scan, and sex hormones (testosterone estradiol, and sex hormone binding globulin) were determined. RESULTS TAFI and CRP were higher in women with PCOS, than controls. In women with PCOS, fibrin lysability correlated with CFM, waist-to-hip ratio, CRP, fibrinogen, and all hemostatic variables (P ≤ .004) except TAFI and D-dimer. CFM correlated with fibrinogen, CRP, coagulation factor XIII, waist-to-hip ratio, plasminogen, PAI-1, plasmin inhibitor, and TAFI (P < .02). In controls, fibrin lysability correlated with CFM, fibrinogen, coagulation factor XIII, and plasmin inhibitor (P ≤ .02). CFM correlated with PAI-1, plasmin inhibitor, coagulation factor XIII, fibrinogen, and CRP (P ≤ .05). Stepwise regression analysis revealed that fibrin lysability was associated with CFM, fibrinogen and CRP in women with PCOS (r2 = .46, P ≤ .001), but only with CFM in controls (r2 = .28, P < .001). CONCLUSIONS Fibrin lysability was comparable in women with PCOS and controls. Fibrin lysability was associated with CFM and hyper-inflammation in women with PCOS, but only with CFM in controls. These findings suggest that obese women with PCOS and augmented inflammation could have an increased risk of cardiovascular disease.
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Affiliation(s)
- Anne C M Godtfredsen
- Unit for Thrombosis Research, Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Esbjerg, Denmark.,Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Obstetrics and Gynecology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Johannes J Sidelmann
- Unit for Thrombosis Research, Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Esbjerg, Denmark.,Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jørgen B Gram
- Unit for Thrombosis Research, Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Esbjerg, Denmark.,Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Marianne Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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Yamada-Nomoto K, Yoshino O, Akiyama I, Iwase A, Ono Y, Nakamura T, Harada M, Nakashima A, Shima T, Ushijima A, Osuga Y, Chang RJ, Shimasaki S, Saito S. PAI-1 in granulosa cells is suppressed directly by statin and indirectly by suppressing TGF-β and TNF-α in mononuclear cells by insulin-sensitizing drugs. Am J Reprod Immunol 2017; 78. [PMID: 28337819 DOI: 10.1111/aji.12669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/22/2017] [Indexed: 02/06/2023] Open
Abstract
PROBLEM Plasminogen activator inhibitor-1 (PAI-1) is elevated in women with polycystic ovary syndrome (PCOS), but the regulation in granulosa cells (GCs) is unclear. METHOD OF STUDY PAI-1 expression in PCOS ovaries was investigated immunohistologically. PAI-1 expressions in HGrC1, a human GC cell line, were investigated at mRNA and activity levels. The expressions of TGF-β and TNF-α in peritoneal fluid mononuclear cells (PFMCs) were measured with quantitative PCR. RESULTS Little PAI-1 expression is observed in healthy GCs, whereas GCs of PCOS and atretic follicle exhibit distinct expression in vivo. In vitro study using HGrC1 shows that TGF-β and TNF-α increase PAI-1 mRNA and its activity, and both together exhibit a synergistic effect. The expression of PAI-1 mRNA is suppressed by simvastatin. Moreover, insulin-sensitizing drugs (metformin, pioglitazone, and rosiglitazone) suppress LPS-induced TGF-β and TNF-α mRNA expression in PFMC. CONCLUSION Statin and insulin-sensitizing drugs may provide a potential therapy for PCOS via down-regulation of PAI-1 expression in GCs and down-regulation of TGF-β and TNF-α expression in PFMC, respectively.
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Affiliation(s)
- Kaori Yamada-Nomoto
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Ikumi Akiyama
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Nagoya University, Nagoya, Japan
| | - Yosuke Ono
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University, Nagoya, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Akitoshi Nakashima
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Tomoko Shima
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Akemi Ushijima
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Russell Jeffrey Chang
- Department of Reproductive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Shunichi Shimasaki
- Department of Reproductive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
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Insenser M, Montes-Nieto R, Murri M, Escobar-Morreale HF. Proteomic and metabolomic approaches to the study of polycystic ovary syndrome. Mol Cell Endocrinol 2013; 370:65-77. [PMID: 23422073 DOI: 10.1016/j.mce.2013.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/05/2013] [Accepted: 02/11/2013] [Indexed: 12/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is considered a complex multifactorial disorder resulting from the interaction of genetic, environmental, and lifestyle influences. Nontargeted proteomics and metabolomics have been used in the past years with the aim of identifying molecules potentially involved in the pathophysiology of this frequent disorder. The biomolecules identified so far participate in many metabolic pathways, including energy metabolism (glucose and lipid metabolism), protein metabolic processes and protein folding, cytoskeleton structure, immune response, inflammation and iron metabolism, fibrinolysis and thrombosis, oxidative stress and intracellular calcium metabolism. These molecules provide key information about molecular functions altered in PCOS and raise questions concerning their precise role in the pathogenesis of this syndrome. The biomolecules identified by nontargeted proteomic and metabolomic approaches should be considered as candidates in future studies aiming to define specific molecular phenotypes of PCOS.
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Affiliation(s)
- María Insenser
- Diabetes, Obesity and Human Reproduction Research Group, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, E-28034 Madrid, Spain
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Shan Y, Wang A, Sun Y, Jiang W, Pang B, An Z, Du X, Wang W, Huang Z. Coagulation and fibrinolytic indices during the first trimester of pregnancy in women with polycystic ovary syndrome: a preliminary study. Reprod Sci 2013; 20:1390-7. [PMID: 23585337 DOI: 10.1177/1933719113485293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the levels of coagulation and fibrinolytic markers during the first trimester of pregnancy in women with polycystic ovary syndrome (PCOS) and determine the effects of PCOS and obesity on the levels of these hemostatic markers. METHODS A cross-sectional study was conducted in Beijing, China, on women with PCOS (n = 50), healthy women (n = 50), pregnant women with PCOS (n = 50), and healthy pregnant women (n = 50) at 12 weeks of pregnancy. Coagulation and fibrinolytic parameters were measured. RESULTS The interaction between PCOS and pregnancy appears to exert effects on the activities of coagulation factors VIII and X. The interaction between PCOS and obesity also seems to affect the level of von Willebrand factor. CONCLUSIONS Pregnant women with PCOS, especially women who are obese, are observed to be in a more prohemostatic state during the first trimester.
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Affiliation(s)
- Yu Shan
- 1Obstetrics and Gynecology Department of Navy General Hospital of Chinese PLA, Beijing, China
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Koiou E, Tziomalos K, Dinas K, Katsikis I, Kandaraki EA, Tsourdi E, Mavridis S, Panidis D. Plasma plasminogen activator inhibitor-1 levels in the different phenotypes of the polycystic ovary syndrome. Endocr J 2012; 59:21-9. [PMID: 21996594 DOI: 10.1507/endocrj.ej11-0023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We aimed to evaluate plasma plasminogen activator inhibitor-1 (PAI-1) antigen levels in women with polycystic ovary syndrome (PCOS) and different levels of adiposity and PCOS phenotypes. We studied 199 women with PCOS and 50 age-matched healthy women divided in normal weight (n=100 and n=25, respectively) and overweight/obese (n=99 and n=25, respectively). Normal weight and overweight/obese patients with PCOS were further divided in patients diagnosed according to the 1990 criteria (i.e. with anovulation and hyperandrogenemia; 1990 criteria group) and in patients with the additional phenotypes introduced in 2003 (i.e. with polycystic ovaries and either anovulation or hyperandrogenemia; additional 2003 criteria group). In normal weight subjects, plasma PAI-1 levels did not differ between women with PCOS (regardless of group) and controls, or between the 1990 criteria and the additional 2003 criteria groups of PCOS. In overweight/obese subjects, plasma PAI-1 levels were higher in both the 1990 criteria and the additional 2003 criteria groups of PCOS compared with controls (p<0.001 and p=0.004, respectively), but did not differ between the 1990 criteria and the additional 2003 criteria groups of PCOS. In conclusion, plasma PAI-1 levels are elevated in overweight/obese women with PCOS but not in normal weight women with this syndrome. Plasma PAI-1 levels do not differ between the phenotypes of PCOS.
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Affiliation(s)
- Ekaterini Koiou
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Abstract
Hypertension is a significant contributor to the risk for cardiovascular disease. The increased prevalence of hypertension in women with polycystic ovary syndrome (PCOS) may contribute to the increased risk of cardiovascular disease in these women. Whether hypertension is associated with PCOS independent of obesity remains controversial. Nevertheless, detection and subsequent treatment of hypertension in this population should decrease the adverse sequelae from hypertensive cardiovascular disease. Treatment of risk factors inherent to PCOS, such as hyperandrogenism, insulin resistance, and obesity, may minimize the risk not only for the development of hypertension but also for incident cardiovascular disease independent of hypertension.
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Affiliation(s)
| | - Ellen Seely
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, MA
| | - Andrea Dunaif
- Division of Endocrinology, Northwestern University, Chicago, IL
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Toulis KA, Goulis DG, Mintziori G, Kintiraki E, Eukarpidis E, Mouratoglou SA, Pavlaki A, Stergianos S, Poulasouchidou M, Tzellos TG, Makedos A, Chourdakis M, Tarlatzis BC. Meta-analysis of cardiovascular disease risk markers in women with polycystic ovary syndrome. Hum Reprod Update 2011; 17:741-60. [PMID: 21628302 DOI: 10.1093/humupd/dmr025] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The relation between polycystic ovary syndrome (PCOS) and cardiovascular disease (CVD) remains unclear. In an attempt to provide high-quality evidence on the relation between PCOS and CVD, relevant literature for CVD risk markers [C-reactive protein (CRP), homocysteine (Hcy), tumor necrosis factor-alpha (TNF-α), plasminogen activator inhibitor-1 (PAI-1), lipoprotein (a) [Lp(a)], advanced glycation end-products (AGEs), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), asymmetric dimethylarginine (ADMA), endothelin-1 (ET-1) and fibrinogen] in women with PCOS was reviewed and analyzed. METHODS A systematic search was conducted electronically using specific eligibility criteria. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated and combined appropriately. To ensure synthesis of the best available evidence, sensitivity analyses were performed. RESULTS A total of 130 data sets were included in 11 different outcomes, involving 7174 and 5076 CVD markers in women with PCOS and controls, respectively. Women with PCOS demonstrated significantly elevated CRP [WMD (95% CI) 0.99 (0.77-1.21)], Hcy [2.25 (1.46-3.03)], PAI-1 antigen [16.96 (7.25-26.28)], PAI-1 activity [0.71 (0.18-1.23)], VEGF [1.72 (0.96-2.48)], ADMA [0.19 (0.08-0.3)], AGEs [3.91 (2.36-5.45)] and Lp(a) [0.81 (0.58-1.04)] concentrations compared with controls, yet with significant between-study heterogeneity. Borderline significance (not robust in the sensitivity analyses) was detected for TNF-α [0.75 (0.07-1.44)], ET-1 [1.06 (0.52-1.59)] and fibrinogen [0.20 (0.01-0.39)], whereas no difference was detected for IL-6 [0.71 (-0.16 to 1.59)]. CONCLUSIONS Women with PCOS have increased serum concentrations of CVD risk markers compared with controls. Whether this apparent risk is translated into increased incidence of CVD in later life remains to be elucidated.
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Affiliation(s)
- Konstantinos A Toulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, 56403 Nea Efkapria, Thessaloniki, Greece
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Mannerås-Holm L, Baghaei F, Holm G, Janson PO, Ohlsson C, Lönn M, Stener-Victorin E. Coagulation and fibrinolytic disturbances in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2011; 96:1068-76. [PMID: 21252248 DOI: 10.1210/jc.2010-2279] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Studies of fibrinolysis/coagulation status in women with polycystic ovary syndrome (PCOS) are contradictory. OBJECTIVES The aim of the study was to investigate whether women with PCOS have disturbed circulating levels of fibrinolysis/coagulation markers and, if so, whether the disturbances are related to hemodynamics, metabolic variables, sex steroids, SHBG, lipids, and inflammatory variables in women with PCOS. DESIGN/MAIN OUTCOME MEASURES: Anthropometric variables, hemodynamics, circulating hemostatic and inflammatory markers, and serum lipid profile were measured in women with untreated PCOS (n = 74) and controls (n = 31). RESULTS After adjustments for age and body mass index (BMI), circulating plasminogen activator inhibitor 1 (PAI-1) activity and fibrinogen levels were higher in women with PCOS than controls; lipid profile, blood pressure, and levels of D-dimer, von Willebrand factor, factor VIII, tissue plasminogen activator, and inflammatory markers were comparable in the two groups. In multiple linear regression analyses including women with PCOS, low SHBG and high insulin predicted high PAI-1 activity (R(2) = 0.526; P < 0.001); elevated high-sensitivity C-reactive protein and soluble E-selectin in combination with heart rate predicted high fibrinogen (R(2) = 0.333; P < 0.001). Differences in PAI-1 activity were not significant after adjustments for age, BMI, SHBG, and insulin. CONCLUSIONS PCOS is characterized by a prothrombotic state, as reflected by increased PAI-1 activity and fibrinogen, without signs of dyslipidemia or a proinflammatory state. Low SHBG and high insulin may partly explain the BMI-independent difference in PAI-1 activity between women with PCOS and controls. High-sensitivity C-reactive protein and E-selectin may be involved in regulating fibrinogen in PCOS.
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Affiliation(s)
- Louise Mannerås-Holm
- Department of Physiology, Institute of Neuroscience and Physiology, SahlgrenskaAcademy, University of Gothenburg, 405 30 Gothenburg, Sweden
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