Patient Care Endocrinology & Cardiology - December 2007 - (Page 17)

Cardiovascular and metabolic implications of polycystic ovary syndrome Are women with polycystic ovary syndrome at increased risk of cardiovascular disease and if so, what preventive measures need to be addressed? CONTRIBUTOR MARIA V. GIBSON, MD, PhD, Medical Director, University Family Medicine; and Assistant Professor, Department of Family Medicine, Medical University of South Carolina, Charleston P Case presentation A 23-year-old woman with a chief complaint of amenorrhea for 2 months, irregular menstrual periods, and a 10-lb weight gain within the past 12 months was seen by her family physician. She is concerned about infertility because home pregnancy tests have been negative. Her menses have been irregular since menarche at age 12. Usually she has 4 to 7 menses per year. With moderate flow, the menses last 4 to 6 days. She is sexually active with one partner and was taking oral contraceptive pills (OCPs) until 12 months ago when she married. She prefers to restart OCPs to normalize her menstrual cycle. The patient has no other medical problems but has been treated for facial acne. She does not smoke and she drinks occasionally. She has a healthy diet and jogs twice a week for 30 minutes. Both parents have hypertension and are overweight. Her father has diabetes, hyperlipidemia, and recently had balloon angioplasty. On physical exam, the patient is 64 in and weighs 176 lb; body mass index is 30.2 kg/m2; BP is 128/78 mm Hg. The skin exam is significant for mild facial acne and acanthosis nigricans on the back of her neck and beneath her breasts. She has some soft hair growing on the nasolabial fold and some terminal hairs growing on the upper lip and under the chin, for which she has had laser therapy. Otherwise her exam, including pelvic is normal. She is concerned about being able to become pregnant, irregular menses, weight gain, and the risk of heart disease. Based on her history of irregular menses and signs of hirsutism combined with obesity, polycystic ovary syndrome is suspected. Does this patient need additional work up? What are the short- and long-term treatment goals? What are her risks for cardiovascular disease? olycystic ovary syndrome (PCOS) is the most common endocrine abnormality in reproductive-aged women in the United States, with prevalence of 4% to 6%.1 PCOS, first described in 1935 as a syndrome characterized by chronic anovulatory cycles and menstrual disorders, is considered a metabolic disorder associated with type 2 diabetes, hypertension, and dyslipidemia, and possibly cardiovascular disease (CVD).2 PCOS represents an interesting biological model illustrating hormonal effects on cardiovascular risks. Worldwide, CVD is the leading cause of death in women, accounting for one-third of all deaths.3 Questions for the primary care physician to ponder include • Is CVD more common, and does it occur at an earlier age in women with PCOS? • What are the metabolic risk factors that put these women at an increased risk of CVD? • What are the CVD preventive measures that need to be addressed for women with PCOS? DIAGNOSTIC CRITERIA According to the International Rotterdam Consensus Group 2003, PCOS remains a syndrome and, as such, no single diagnostic criterion is sufficient for clinical diagnosis. Furthermore, controversy regarding the characteristics of PCOS still remains. The Rotterdam group recommended that diagnosis of PCOS requires at least 2 of the following 3 criteria: oligo-ovulation or anovulation or both; clinical or biochemical signs of hyperandrogenism or both; and polycystic ovaries on ultrasonography.4 A 2002 American College of Obstetricians and DECEMBER 2007 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY 17

Table of Contents Feed for the Digital Edition of Patient Care Endocrinology & Cardiology - December 2007

Patient Care Endocrinology & Cardiology - December 2007 Research Digest Contents Medicine in the News Options for Managing Diabetes: Three Types of Basal Insulin Therapy Using the New AHA Guidelines for Preventing Coronary Heart Disease in Women Cardiovascular and Metabolic Implications of Polycystic Ovary Syndrome Case & Comment Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - December 2007

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