Effects of metformin and ethinyl estradiol–cyproterone acetate on lipid levels in obese and non-obese women with polycystic ovary syndrome

Abstract

Objective: Women with polycystic ovary syndrome (PCOS) exhibit risk factors for cardiovascular diseases such as abdominal obesity, insulin resistance and dyslipidemia. Insulin sensitizers, especially metformin, have been shown to improve these metabolic disturbances, but there are only a few studies on their effects on serum lipids in polycystic ovary syndrome. Methods: Thirty-five women with PCOS (18 obese and 17 non-obese) were randomized to 6-month treatments with metformin or ethinyl estradiol -cyproterone acetate oral contraceptive pills. Results: In the whole-study population (non-obese and obese women) serum levels of high-density lipoprotein cholesterol increased from 1.4^0.2 to 1.6^0.1 mmol/l (means^S.E. throughout) at 3 and 6 months (P , 0.001), the total cholesterol:high-density lipoprotein cholesterol ratio decreased significantly from 3.8^0.3 to 3.3^0.2 at 6 months (P , 0.001) and a similar trend was observed in serum triglyceride levels during metformin treatment. In the oral contraceptive group, serum levels of total cholesterol increased from 4.9^0.3 to 5.4^0.3 mmol/l (P , 0.05), high-density lipoprotein cholesterol increased from 1.2^0.1 to 1.5^0.1 mmol/l (P , 0.001), the total cholesterol:high-density lipoprotein cholesterol ratio decreased from 4.6^0.4 to 3.7^0.2 (P , 0.001) and triglycerides increased from 1.3^0.1 to 1.9^0.2 mmol/l at 6 months of treatment (P , 0.001). Serum low-density lipoprotein cholesterol levels remained unchanged during both treatments. Milder but similar changes in the subgroups of obese and non-obese women were observed during both treatments. Moreover, in the whole-study population both systolic (P ¼ 0.02) and diastolic (P ¼ 0.05) blood pressures decreased over the 6 months of metformin treatment. Conclusion: In women with PCOS, metformin treatment had beneficial effects on lipid profile and blood pressure, and therefore it could be useful in the prevention of cardiovascular complications in these women. 152 269-275 European Journal of Endocrinology

Metformin administration improves leukocyte count in women with polycystic ovary syndrome: a 6-month prospective study

“…Thus, here we demonstrate for the first time a positive effect of metformin on the low-grade chronic inflammation, both leukocyte counts and CRP in PCOS women. The decrease in serum CRP levels during metformin therapy is in accordance with the known beneficial metabolic effects of this drug and suggests that CRP or other inflammatory parameters could be used as markers for the efficiency of therapy in PCOS (37). However, our group recently demonstrated that CRP levels also improved after a 3-month well-structured exercise training program in PCOS patients, showing the beneficial effects of a nonpharmacological therapeutic strategy (18).…”

Role of the N, N′-dimethylbiguanide metformin in the treatment of female prepuberal BALB/c mice hyperandrogenized with dehydroepiandrosterone

“…Although the action of this biguanide on improving lipid metabolism has been widely reported (Caballero 2004, Dominguez & Sowers 2005, Rautio et al 2005, our data represent the first evidence that metformin modulates the production of ovarian prostaglandins.…”

Polycystic Ovary Syndrome and Cardiovascular Disease

“…Study results regarding the effects of metformin on primary prevention of CVD are not coherent (Moghetti, Castello et al 2000;Diamanti-Kandarakis, Alexandraki et al 2005;Rautio, Tapanainen et al 2005). Metformin has a little influence on body weight (less than 2-3% of BMI) (Moghetti, Castello et al 2000;Rautio, Tapanainen et al 2005;Nieuwenhuis-Ruifrok, Kuchenbecker et al 2009) and may ameliorate atherogenic dyslipidemia, raising HDL-C and lowering triglycerides (Rautio, Tapanainen et al 2005;Trolle, Flyvbjerg et al 2007).…”

“…Metformin has a little influence on body weight (less than 2-3% of BMI) (Moghetti, Castello et al 2000;Rautio, Tapanainen et al 2005;Nieuwenhuis-Ruifrok, Kuchenbecker et al 2009) and may ameliorate atherogenic dyslipidemia, raising HDL-C and lowering triglycerides (Rautio, Tapanainen et al 2005;Trolle, Flyvbjerg et al 2007). Nevertheless, no alterations in HDL-C or triglycerides were seen in some studies (Banaszewska, Pawelczyk et al 2009).…”

“…Nevertheless, no alterations in HDL-C or triglycerides were seen in some studies (Banaszewska, Pawelczyk et al 2009). Metformin cannot improve LDL-C or non-HDL-C (Rautio, Tapanainen et al 2005;Trolle, Flyvbjerg et al 2007;Banaszewska, Pawelczyk et al 2009). Furthermore, several studies with metformin have shown that, it lessens of circulating C-reactive protein, PAI-1 (Velazquez, Acosta et al 1997;Morin-Papunen, Rautio et al 2003) and may ameliorate premature atherosclerosis, decrease carotid IMT and enhance endothelial function (Diamanti-Kandarakis, Alexandraki et al 2005;Agarwal, Rice et al 2010).…”