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Predictors of Endothelial Dysfunction in Young Women with Polycystic Ovary Syndrome

Department of Endocrinology (M.K., A.T.) and Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology (S.N.K., E.A.P.), University Hospital, 45 110 Ioannina, Greece; Michaelidion Cardiac Center (K.K.N., N.K., C.S.K., L.K.M.), University of Ioannina, 45 110 Ioannina, Greece; Department of Obstetrics and Gynecology (A.M.), University of Crete, 71 110 Heraklion, Greece; and Pediatric and Reproductive Endocrinology Branch (G.P.C.), National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Agathocles Tsatsoulis, M.D., Ph.D., F.R.C.P, Department of Endocrinology, University of Ioannina, Panepistimiou Avenue, 45 110 Ioannina, Greece. E-mail: atsatsou{at}cc.uoi.gr or anaka{at}cc.uoi.gr.

Context: Women with polycystic ovary syndrome (PCOS) may be at increased risk for cardiovascular disease. Endothelial dysfunction is an early marker of atherosclerosis.

Objectives: The objectives of this study were to 1) compare endothelial function in young women with PCOS and regularly menstruating control women, and 2) to identify the determinants of endothelial function and investigate its relationship with body mass index in women with PCOS.

Design: This was a cross-sectional study.

Setting: This study was conducted at a tertiary cardiovascular research center.

Patients: Sixty-two young women with PCOS (mean age, 22.7 yr) and 17 control women, matched as a group for age and body mass index, were studied. Twenty-three women with PCOS were lean, 21 were overweight, and 18 were obese.

Main Outcome Measures: Endothelium-dependent and -independent vascular function was assessed by measuring flow-mediated dilation (FMD) and nitrate-mediated dilation in the brachial artery (diameter change during hand hyperemia and after sublingual glyceryl trinitrate administration, respectively).

Results: FMD and nitrate-mediated dilation were significantly lower in PCOS than in control women (reduced by approximately 50 and 25%, respectively; both P < 0.0005). Insulin resistance, total testosterone, and total cholesterol were independent predictors of FMD, accounting for 21, 10, and 9% of the variance, respectively (P < 0.005 for all). A trend of deterioration in FMD from lean to overweight and obese PCOS women was observed, but differences among groups were not statistically significant.

Conclusions: Women with PCOS have significant endothelial dysfunction at an early age (i.e. early 20s), and largely independent of obesity. This suggests that women with PCOS are at increased risk for early onset cardiovascular disease and may gain particular benefit from measures to improve endothelial function.

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