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A More Atherogenic Serum Lipoprotein Profile Is Present in Women with Polycystic Ovary Syndrome: A Case-Control Study

Department of Gynecology, Divisions of Reproductive Medicine (O.V., J.S.E.L.) and Obstetrics and Prenatal Medicine (R.P.M.S-T., H.P.M.S.), and Departments of Epidemiology and Biostatistics (R.P.M.S.-T.), Clinical Genetics (R.P.M.S.-T.), and Pediatrics/Division of Pediatric Cardiology (R.P.M.S.-T.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Laboratory of Experimental Vascular Medicine (G.M.D.-T.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; and Departments of Reproductive Medicine (B.C.J.M.F.) and Internal Medicine (E.H.W.), University Medical Center, 85500 3508 GA Utrecht, The Netherlands

Address all correspondence and requests for reprints to: O. Valkenburg, M.D., Division of Reproductive Medicine, Department of Gynecology and Obstetrics, Room HS 508, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: o.valkenburg{at}erasmusmc.nl.

Context: Polycystic ovary syndrome (PCOS) is associated with a higher frequency of cardiovascular risk factors. Apolipoprotein (apo) A-I and apoB are potent markers for cardiovascular risk. Data on apo levels in women with PCOS are scarce and contradictory.

Objective: Our objective was to identify changes in lipid metabolism in women with PCOS, and the relative impact of obesity, insulin resistance, and hyperandrogenism on lipid parameters.

Design: This was a case-control study.

Setting: The study was performed at a single referral center.

Subjects: PCOS was diagnosed according to the 2003 Rotterdam criteria. Healthy mothers with regular menstrual cycles served as controls.

Main Outcome Parameters: Fasting insulin, triglycerides (TGs), cholesterol, high-density lipoprotein (HDL)-cholesterol, apoA-I, and apoB were determined. Low-density lipoprotein (LDL)-cholesterol was calculated using the Friedewald formula.

Results: We included 557 women with PCOS and 295 controls. After correction for age and body mass index, PCOS women had higher median levels of insulin (10.1 vs. 6.9 mU/liter), TGs (95 vs. 81 mg/dl), cholesterol (196 vs. 178 mg/dl), and LDL-cholesterol (125 vs. 106 mg/dl) in combination with lower levels of HDL-cholesterol (46 vs. 55 mg/dl) and apoA-I (118 vs. 146 mg/dl) compared with controls (all P values 0.01). apoB levels were similar in cases and controls. Free androgen index, body mass index, SHBG, and estradiol were independent predictors of apoA-I levels in women with PCOS.

Conclusions: PCOS is associated with a more pronounced atherogenic lipid profile. Furthermore, obesity and hyperandrogenism contribute to an adverse lipid profile. Finally, PCOS seems to constitute an additional risk factor for an atherogenic lipid profile.

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