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Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2005-1329
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The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 1 48-53
Copyright © 2006 by The Endocrine Society

Prevalence and Predictors of the Metabolic Syndrome in Women with Polycystic Ovary Syndrome

David A. Ehrmann, David R. Liljenquist, Kristen Kasza, Ricardo Azziz, Richard S. Legro, Mahmoud N. Ghazzi for the PCOS/Troglitazone Study Group1

Departments of Medicine (D.A.E., D.R.L.) and Health Studies (K.K.), The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637; Department of Obstetrics and Gynecology (R.A.), University of Alabama, Birmingham, Alabama 35294; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania 17033; and Pfizer Pharmaceuticals (M.N.G.), Ann Arbor, Michigan 48105

Address all correspondence and requests for reprints to: David A. Ehrmann, M.D., Section of Endocrinology, The University of Chicago, 5841 South Maryland Avenue, MC-1027, Chicago, Illinois 60637. E-mail: dehrmann{at}uchicago.edu.

Context: Polycystic ovary syndrome (PCOS) and the metabolic syndrome have many features in common and may share the same pathogenesis.

Objective: This study was performed to determine the prevalence and predictors of the metabolic syndrome in PCOS.

Design: The clinical, hormonal, and oral glucose tolerance test results were analyzed in 394 PCOS women who were screened for participation in a multicenter trial to evaluate the effects of troglitazone on ovulation and hirsutism.

Setting: A multicenter clinical trial is presented.

Patients or Other Participants: The subjects were women with PCOS who had or lacked the metabolic syndrome.

Main Outcome Measures: Waist circumference, fasting glucose, high-density lipoprotein cholesterol and triglyceride concentrations, and blood pressure were the main outcome measures.

Results: Twenty-six (6.6%) subjects had diabetes; among the 368 nondiabetics, the prevalence for individual components comprising the metabolic syndrome were: waist circumference greater than 88 cm in 80%, high-density lipoprotein cholesterol less than 50 mg/dl in 66%, triglycerides greater than or equal to 150 mg/dl in 32%, blood pressure greater than or equal to 130/85 mm Hg in 21%, and fasting glucose concentrations greater than or equal to 110 mg/dl in 5%. Three or more of these individual criteria were present in 123 (33.4%) subjects overall. The prevalence of the metabolic syndrome did not differ significantly between racial/ethnic groups. The prevalence of the metabolic syndrome from lowest to highest quartile of free testosterone concentration was 19.8, 31.3, 46.9, and 35.0%, respectively [P = 0.056 adjusted for body mass index (BMI)]. None of the 52 women with a BMI less than 27.0 kg/m2 had the metabolic syndrome; those in the top BMI quartile were 13.7 times more likely (95% confidence interval, 5.7–33.0) to have the metabolic syndrome compared with those in the lowest quartile. Thirty-eight percent of those with the metabolic syndrome had impaired glucose tolerance compared with 19% without the metabolic syndrome (P < 0.001).

Conclusions: The metabolic syndrome and its individual components are common in PCOS, particularly among women with the highest insulin levels and BMI. Hyperinsulinemia is a likely common pathogenetic factor for both PCOS and the metabolic syndrome.




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