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Submitted on January 4, 2005
Accepted on July 7, 2005
Monash University Department of Medicine, Dandenong Hospital, Melbourne, Victoria, Australia
* To whom correspondence should be addressed. E-mail: helena.teede{at}med.monash.edu.au.
Context: Polycystic ovary syndrome (PCOS) is associated with insulin resistance (IR) and the metabolic syndrome. There is no adequate data demonstrating significantly increased cardiovascular disease (CVD) mortality. In the absence of clinical outcome studies, surrogate markers of early CVD can provide insight into early CVD.
Objectives: The aim of this study was to clarify whether overweight women with PCOS have an increased prevalence of CV risk factors and early CVD, compared to age and BMI matched controls, to determine the contribution of PCOS per se to CVD status.
Design and patients: Case control study of 100 overweight women with PCOS and 20 subjects of similar BMI and age. Main outcome measures: Non-invasive markers of early CV disease (carotid intimal media thickness [IMT], pulse wave velocity [PWV] and brachial arterial flow mediated vasodilation [FMD]). Metabolic parameters studied included insulin, glucose, CRP, lipid and androgens.
Results: Subjects with PCOS had elevated testosterone (2.5±0.2 vs. 1.3±0.1nmol/l), DHEAS (4.9±0.3 vs. 3.6±0.4mmol/l), fasting insulin (19.6±1.4 vs. 6.8±0.8uU/ml) and HOMA of IR (4.1±0.3 vs. 1.3±0.2) compared to controls. In addition those with PCOS had elevated cholesterol (5.1±0.1 vs. 4.6±0.2mmol/l) and triglycerides (1.4±0.1 vs. 0.9±0.1mmol/l), whilst there were no differences in either CRP or 24hour ambulatory blood pressure parameters. Subjects with PCOS also had increased arterial stiffness (PWV 7.4±0.1 vs. 6.6±0.2m/s) and endothelial dysfunction (FMD 9.8±0.4 vs. 13.3±0.9) compared to controls. There was no difference in mean IMT between the groups. Stepwise regression in PCOS subjects showed that IR and lipids were independent predictors of PWV.
Conclusion: Overweight women with PCOS have increased CV risk factors and evidence of early CVD compared to weight matched controls, potentially related to IR.
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