Association of Hyperandrogenemic and Metabolic Phenotype with Carotid Intima-Media Thickness in Young Women with Polycystic Ovary Syndrome

Abstract

Polycystic ovary syndrome (PCOS), a common endocrinopathy of women of reproductive age, is associated with the early appearance of multiple risk factors for cardiovascular disease, such as abdominal obesity, dyslipidemia, and diabetes mellitus. However, premature atherosclerosis of the carotid artery has not yet been demonstrated in young women with PCOS. Measurement of carotid intima-media thickness (IMT) is considered an easy and reliable index of subclinical atherosclerosis, which is predictive of subsequent myocardial infarction and stroke. To evaluate the cardiovascular risk of PCOS and the participation of the hyperandrogenemic and metabolic pattern, we measured carotid IMT by B-mode ultrasound as well as hormonal and several cardiovascular disease-associated parameters in 75 young women with PCOS and 55 healthy, age- and body mass index-matched women. The PCOS women had significantly increased carotid IMT (0.58 vs. 0.47 mm, P < 0.001) and abdominal adiposity; higher levels of androgens, insulin, homeostasis model assessment score of insulin sensitivity, and total and low-density lipoprotein-cholesterol; and significantly lower levels of SHBG and high-density lipoprotein-cholesterol. In the studied population (n = 130), PCOS status, age, body mass index, and parental history of coronary heart disease were strong positive predictors of carotid IMT, whereas dehydroepiandrosterone sulfate was a strong negative predictor. In PCOS patients lower delta4-androstenedione and high-density lipoprotein-cholesterol levels were additionally strong positive predictors of carotid IMT, whereas in control women only total cholesterol was the additional positive predictor of carotid IMT. In conclusion, young women with PCOS have an early increase of cardiovascular risk factors and greater carotid IMT, both of which may be responsible for subclinical atherosclerosis. The hyperandrogenemic phenotype of the syndrome may attenuate the consequences of the dysmetabolic phenotype on the vascular wall.

Correlation between serum lipid profile and carotid intima-media thickness in Polycystic Ovarian Syndrome

“…This suggested that Cholesterol particularly LDL-C fraction increase was responsible for atherosclerosis and increased mean carotid IMT among PCOS women. Our study has been supported by the findings of Vryonidou et al (21), who found significantly higher carotid IMT (0.58 vs 0.47 mm, P < 0.001) among young women with PCOS (17-35 yrs) as compared to healthy controls.…”

The polycystic ovary syndrome (pcos) status and cardiovascular risk in young women

“…Conflicting results have been provided regarding the factors associated with impaired vascular reactivity in PCOS. The relationship with hyperandrogenemia is especially controversial, since the effect of the androgens was described as either adverse [10,25], neutral [24,26], or even protective in patients with PCOS [27]. However, the reports are more constant with regard to ET-1 and the deleterious effect that markers of hyperandrogenemia have on it [3,9,10].…”

“…A control group composed of 32 women (age: 23.06 ±5.37 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), BMI: 25.87± 6.89 (16.88-42.86) kg/m 2 ) was selected as to be similar to the group of patients in terms of age and BMI. In the end though, our intention was not fully accomplished because there was still a significant difference in BMI between the groups.…”

Polycystic Ovary Syndrome and Cardiovascular Disease

“…However, the report by Orio et al ., showed a strong association between CIMT and the free androgen index that suggests a contribution of hyperandrogenemia to evolvement of atherosclerosis in PCOS . Contrarily, in a larger study raised CIMT was conversely correlated with plasma DHEAS and androstenedione concentrations, proposing a fascinating vasculoprotective influence of hyperandrogenemia in PCOS (Vryonidou, Papatheodorou et al 2005). Meyer et al also found a similar vasculoprotective effect of DHEAS in a study involving 80 obese women with PCOS, where higher DHEAS corresponded to notably lower CIMT (Meyer, McGrath et al 2005).…”