Cardiovascular Risk in Women With Polycystic Ovary Syndrome
Cardiovascular Risk in Women With Polycystic Ovary Syndrome
Background: Women with polycystic ovary syndrome (PCOS) have been reported to have subclinical cardiovascular disease (CVD) and increased abdominal fat. The aim of this study was to evaluate the relationship between visceral fat (VF) and early markers of CVD in PCOS women.
Methods: Two hundred overweight PCOS women [(mean ± SD) age 24.6 ± 3.2 years, body mass index (BMI) 28.5 ± 2.8 kg/m] and 100 healthy age- and BMI-matched volunteer controls entered this cross-sectional study. In all subjects, the amount of VF was measured by ultrasonography. Anthropometric measurements [BMI and waist circumference (WC)], complete hormonal and metabolic pattern, carotid intima-media thickness (IMT), brachial arterial flow-mediated dilation (FMD) and inflammatory biomarkers [C-reactive protein (CRP), fibrinogen, white blood cells count and plasminogen activated inhibitor-1] were also obtained from all subjects. A stepwise linear regression model was used in PCOS patients to verify if IMT or FMD as dependent variables are affected by other independent variables.
Results: VF amount was significantly (P < 0.001) higher in PCOS subjects than in healthy controls [31.4 ± 7.3 versus 28.0 ± 6.1 (mean±SD) mm, respectively] and directly related to insulin resistance: HOMA (r = 0.918, P < 0.001) and AUCINS (r = 0.879, P < 0.001), and to WC (r = 0.658; P < 0.001). In PCOS, the two linear regression analyses showed that IMT is positively affected by VF and CRP, whereas FMD is positively affected by IMT and negatively by VF and CRP.
Conclusions: VF amount is associated with subclinical CVD in PCOS patients.
The polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disease, affecting ~5-10% of women of reproductive age (Ehrmann, 2005). PCOS is associated with an adverse metabolic and cardiovascular risk (CVR) profile, including obesity, insulin resistance (IR), dyslipidemia and low-grade chronic inflammation (Ovalle and Azziz, 2002; Orio et al., 2006).
Obesity, and specifically central obesity, is a common PCOS feature that worsens its phenotype (Gambineri et al., 2002). Compared with weight-matched healthy women, those with PCOS have a similar amount of total and trunk fat, but a higher quantity of central abdominal fat (Carmina et al., 2007). Additionally, central fat excess is associated with an increase in low-grade chronic inflammation and IR (Puder et al., 2005; Carmina et al., 2007) and with metabolic dysfunction in women with PCOS (Lord et al., 2006).
Increased visceral fat (VF) may also be present in non-obese PCOS women, likely contributing to development of glucose and lipid metabolism disorders (Yildrim et al., 2003).
Excess visceral or periomental fat seems to be predictive not only of the metabolic syndrome but also of cardiovascular disease (CVD) (Sowers, 1998; Grundy, 2002). VF is indeed a source of several hormones and cytokines inducing a proinflammatory state and oxidative damage leading to initiation and progression of atherosclerosis (Panagiotakos et al., 2005). In fact, subclinical CVD and early impairment of endothelial structure and function have been previously reported in PCOS women (Tiras et al., 1999; Paradisi et al., 2001; Orio et al., 2004a,b; Lakhani et al., 2005; Vural et al., 2005; Cussons et al., 2006).
Although magnetic resonance imaging (MRI) and computerized tomography (CT) represent the gold standard procedures for assessing the amount of VF, the use of these techniques is limited by exposition to ionizing radiation, high costs and limited availability. Ultrasonography (US) is considered a cost-effective, reliable and precise imaging tool for assessing the amount of visceral adipose tissue (Iacobellis, 2005, Palomba et al., 2007) and even for identifying patients at high CVD risk (Ribeiro-Filho et al., 2001; Kim et al., 2004).
On the basis of these considerations, the present study was carried out to evaluate whether the amount of VF may be considered as predictor for early CVD in PCOS, and to investigate the potential relationship between VF and some CVR factors and early atherosclerotic markers in PCOS.
Background: Women with polycystic ovary syndrome (PCOS) have been reported to have subclinical cardiovascular disease (CVD) and increased abdominal fat. The aim of this study was to evaluate the relationship between visceral fat (VF) and early markers of CVD in PCOS women.
Methods: Two hundred overweight PCOS women [(mean ± SD) age 24.6 ± 3.2 years, body mass index (BMI) 28.5 ± 2.8 kg/m] and 100 healthy age- and BMI-matched volunteer controls entered this cross-sectional study. In all subjects, the amount of VF was measured by ultrasonography. Anthropometric measurements [BMI and waist circumference (WC)], complete hormonal and metabolic pattern, carotid intima-media thickness (IMT), brachial arterial flow-mediated dilation (FMD) and inflammatory biomarkers [C-reactive protein (CRP), fibrinogen, white blood cells count and plasminogen activated inhibitor-1] were also obtained from all subjects. A stepwise linear regression model was used in PCOS patients to verify if IMT or FMD as dependent variables are affected by other independent variables.
Results: VF amount was significantly (P < 0.001) higher in PCOS subjects than in healthy controls [31.4 ± 7.3 versus 28.0 ± 6.1 (mean±SD) mm, respectively] and directly related to insulin resistance: HOMA (r = 0.918, P < 0.001) and AUCINS (r = 0.879, P < 0.001), and to WC (r = 0.658; P < 0.001). In PCOS, the two linear regression analyses showed that IMT is positively affected by VF and CRP, whereas FMD is positively affected by IMT and negatively by VF and CRP.
Conclusions: VF amount is associated with subclinical CVD in PCOS patients.
The polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disease, affecting ~5-10% of women of reproductive age (Ehrmann, 2005). PCOS is associated with an adverse metabolic and cardiovascular risk (CVR) profile, including obesity, insulin resistance (IR), dyslipidemia and low-grade chronic inflammation (Ovalle and Azziz, 2002; Orio et al., 2006).
Obesity, and specifically central obesity, is a common PCOS feature that worsens its phenotype (Gambineri et al., 2002). Compared with weight-matched healthy women, those with PCOS have a similar amount of total and trunk fat, but a higher quantity of central abdominal fat (Carmina et al., 2007). Additionally, central fat excess is associated with an increase in low-grade chronic inflammation and IR (Puder et al., 2005; Carmina et al., 2007) and with metabolic dysfunction in women with PCOS (Lord et al., 2006).
Increased visceral fat (VF) may also be present in non-obese PCOS women, likely contributing to development of glucose and lipid metabolism disorders (Yildrim et al., 2003).
Excess visceral or periomental fat seems to be predictive not only of the metabolic syndrome but also of cardiovascular disease (CVD) (Sowers, 1998; Grundy, 2002). VF is indeed a source of several hormones and cytokines inducing a proinflammatory state and oxidative damage leading to initiation and progression of atherosclerosis (Panagiotakos et al., 2005). In fact, subclinical CVD and early impairment of endothelial structure and function have been previously reported in PCOS women (Tiras et al., 1999; Paradisi et al., 2001; Orio et al., 2004a,b; Lakhani et al., 2005; Vural et al., 2005; Cussons et al., 2006).
Although magnetic resonance imaging (MRI) and computerized tomography (CT) represent the gold standard procedures for assessing the amount of VF, the use of these techniques is limited by exposition to ionizing radiation, high costs and limited availability. Ultrasonography (US) is considered a cost-effective, reliable and precise imaging tool for assessing the amount of visceral adipose tissue (Iacobellis, 2005, Palomba et al., 2007) and even for identifying patients at high CVD risk (Ribeiro-Filho et al., 2001; Kim et al., 2004).
On the basis of these considerations, the present study was carried out to evaluate whether the amount of VF may be considered as predictor for early CVD in PCOS, and to investigate the potential relationship between VF and some CVR factors and early atherosclerotic markers in PCOS.