Patient Care Endocrinology & Cardiology - December 2007 - (Page 19)

Polycystic ovary syndrome I linemia is most marked when there is an interaction between obesity and PCOS.7 At the same time, insulin resistance, assessed by invasive dynamic tests, is not consistently documented in all women with PCOS.7 Women with PCOS have a 5- to 10-fold increased risk of developing type 2 diabetes compared to age- and weight-matched women. There is a 31% to 35% prevalence of impaired glucose tolerance and 7.5% to 10% prevalence of diabetes in women with PCOS.8 Endothelial and altered vascular function These factors have been shown to be associated with both elevated androgen levels and insulin resistance in women with PCOS.9,10 In a prospective controlled study in selected young women with PCOS, impaired glucose tolerance and hypertriglyceridemia or hypercholesterolemia was associated with an increased left ventricular mass and decreased left ventricular performance and diastolic filling.11 Most of the abnormalities persisted even in young patients with normal weight, suggesting that the pathogenesis of cardiac abnormalities in PCOS is not only dependent on BMI. At present, however, the cardiovascular effects of androgens remain unclear despite recent reports. One study found that elevated levels of dehydroepiandrosterone sulfate improve endothelial dysfunction seen in women with PCOS and may offer a cardioprotective advantage that attenuates the effects of the cardiovascular risk factors that accompany PCOS.12,13 In addition, there are reports about vascular protective effects of androgens, including prevention of platelet aggregation, reduction of cholesterol uptake, and decrease of vascular smooth muscle cell proliferation.14,15 Premature atherosclerosis It has been suggested that the chronically abnormal hormonal and metabolic changes in women with PCOS, starting at adolescence, may predispose them to premature atherosclerosis. Significant associations have been shown between the presence of polycystic ovaries and the presence and severity of cardiovascular artery disease and family history of MI as well as with elevated levels of insulin and triglycerides and lower levels of HDL cholesterol. In one study based on cal- TABLE 1 Causes of androgen excess other than PCOS Acromegaly Androgen-secreting tumors of the ovary or adrenal gland Cushing’s syndrome Exogenous androgens Genetic defects in insulin action Nonclassic (late-onset) congenital adrenal hyperplasia Primary hypothalamic amenorrhea Primary ovarian failure Prolactin disorders Thyroid disease Key: PCOS, polycystic ovary syndrome. culated risk profiles, women with PCOS were predicted to have a 7-fold increased relative risk for MI.16 When measured by electron beam CT, coronary artery calcium in 30- to 45-year-old premenopausal women with PCOS was significantly more prevalent (39%) than in matched controls (21%) or community-dwelling women (9.9%). BMI, waist circumference, and total and LDL-cholesterol levels predicted coronary artery calcium prevalence after adjustment for BMI suggesting that women with PCOS are at increased risk for atherosclerosis and should be targeted for primary prevention of coronary heart disease (CHD).17 Epidemiologic data However, at this point there are no epidemiologic studies showing direct evidence of an increased incidence of CHD events in middle-aged women with a history of PCOS.18 Longterm outcome studies examining the prevalence of CVD among women with PCOS also have failed to demonstrate a significantly increased risk of cardiovascular death.19 Studies in young women with PCOS have shown increased serum markers of premature atherosclerosis such as C-reactive protein and homocysteine, serum plasminogen activator inhibitor levels, and increased carotid artery intima-media thickness on ultrasound, suggesting potential devel- DECEMBER 2007 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY 19

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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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