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Submitted on June 20, 2005
Accepted on October 13, 2005
Department of Medicine and Department of Health Studies, The University of Chicago Pritzker School of Medicine, Chicago, IL; Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL; Department of Obstetrics and Gynecology, The Pennsylvania State University, Hershey, PA; Pfizer Pharmaceuticals, Ann Arbor, MI
* To whom correspondence should be addressed. 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: To determine the prevalence and predictors of the metabolic syndrome in PCOS.
Design: Analysis of clinical, hormonal, and OGTT results in 394 PCOS women who were screened for participation in a multi-center trial to evaluate the effects of troglitazone on ovulation and hirsutism.
Setting: Multi-center clinical trial.
Patients or Other Participants: Women with PCOS who have or lack the metabolic syndrome.
Main Outcome Measures: Waist circumference, fasting glucose, HDL cholesterol and triglyceride concentrations, and blood pressure.
Results: Twenty-six (6.6%) subjects had diabetes; among the 368 nondiabetics, the prevalence for individual components comprising the metabolic syndrome were: waist circumference > 88 cm in 80%, HDL cholesterol < 50 mg/dl in 66%, triglycerides 
150 mg/dl in 32%, blood pressure 130/85 mmHg in 21% and fasting glucose concentrations 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 BMI). None of the 52 women with a BMI < 27.0 kg/m2 had the metabolic syndrome; those in the top BMI quartile were 13.7 times more likely (95% CI 5.7-33.0) to have the metabolic syndrome compared with those in the lowest quartile. 38% 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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