Predictors of Endothelial Dysfunction in Young Women with Polycystic Ovary Syndrome

Kravariti, Maria; Naka, Katerina K.; Kalantaridou, Sophia Ν.; Kazakos, Nikolaos; Katsouras, Christos S.; Makrigiannakis, Antonis; Paraskevaidis, Evangelos; Chrousos, George P.; Tsatsoulis, Agathocles; Michalis, Lampros K.

doi:10.1210/jc.2005-0151

Cited by 165 publications

(97 citation statements)

References 42 publications

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“…It is a cheap, repeatable, and non-invasive measure of endothelial function and provides a unique opportunity for early assessment of possible treatment benefit, complementing endpoints of structural arterial disease and cardiovascular outcomes that take much longer and are more expensive to study (23). We found endothelial dysfunction in young nonobese PCOS patients, which is in concordance with previously published data (12). This suggests that even non-obese PCOS patients have an increased risk for CVD and may gain particular benefit from treatment that improves endothelial function.…”

Section: Discussionsupporting

confidence: 91%

“…Nitrate-mediated vasodilatation was also impaired in PCOS patients compared with control women, in agreement with previous studies (12). The vasodilatory response to GTN is considered to be a function of both vascular smooth muscle relaxation (direct action of GTN on the vascular smooth muscle) and the endothelial response to hyperemia caused by GTNinduced dilatation of the resistance vessels.…”

Section: Parametersupporting

confidence: 91%

“…It has been observed in PCOS patients in several studies (9)(10)(11). Endothelial dysfunction in PCOS is linked to significant abnormalities in androgen levels, lipoprotein profile, blood pressure, and insulin resistance (12). In addition, components of renin-angiotensin-aldosterone system that can induce endothelial dysfunction have been found to be increased in PCOS (13).…”

Section: Introductionmentioning

confidence: 97%

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Influence of spironolactone treatment on endothelial function in non-obese women with polycystic ovary syndrome

Studen¹,

Šebeštjen²,

Pfeifer³

et al. 2011

European Journal of Endocrinology

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Objective: Accumulating evidence connects polycystic ovary syndrome (PCOS) with increased risk of cardiovascular disease. Endothelial dysfunction is present in PCOS and represents an early, reversible marker of cardiovascular damage. As androgens and renin-angiotensin-aldosterone system are implicated in the atherogenesis process of PCOS, we tested the hypothesis that treatment with spironolactone, an androgen and mineralocorticoid receptor blocking drug, might reverse endothelial dysfunction in PCOS. Patients: A total of 30 non-obese PCOS patients, compared with 20 body mass index matched control subjects, were evaluated. PCOS patients were given spironolactone 100 mg daily in 21-day long intervals followed by a 7-day pause, for 6 months. Measurements: Flow-mediated dilatation (FMD), glyceryl trinitrate-induced dilatation, free testosterone, androstenedione, DHEA-sulfate, total, low-density lipoprotein (LDL)-, high-density lipoproteincholesterol, and triglycerides were determined at baseline and after 6 months. Results: Results are expressed as median (25-75th percentile). At baseline, FMD was significantly lower in PCOS patients than in controls: 6.0 (0.0-11.7) vs 10.2 (6.8-15.9) %, PZ0.018. This difference disappeared after 6 months of spironolactone treatment, as FMD in PCOS patients significantly increased to 8.3 (5.7-10.3) %, PZ0.034, and was no longer different from controls. In PCOS patients, serum androgen levels did not change during treatment, while total and LDL-cholesterol decreased significantly from 4.8 (4.1-5.1) mmol/l to 4.4 (3.9-4.8) mmol/l and from 2.5 (2.1-3.1) to 2.2. (2.1-2.5) mmol/l, P!0.05 and P!0.05 respectively. Conclusion: Treatment with spironolactone normalized endothelial function and improved cholesterol levels in non-obese PCOS patients.

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Section: Discussionsupporting

confidence: 91%

Section: Parametersupporting

confidence: 91%

Section: Introductionmentioning

confidence: 97%

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Influence of spironolactone treatment on endothelial function in non-obese women with polycystic ovary syndrome

Studen¹,

Šebeštjen²,

Pfeifer³

et al. 2011

European Journal of Endocrinology

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“…In 2 studies, there was no association, 151,188 whereas other studies reported significant associations of testosterone with endothelial dysfunction. 153,154,189 In contrast, an inverse association of the adrenal androgen dehydroepiandrosterone sulfate has been seen with carotid intimamedia thickness in PCOS. 145,152 Multiple intervention studies have shown that therapy that increases insulin sensitivity can improve endothelial function 190,191 more than oral contraceptives 192 and in combination with oral contraceptives.…”

Section: The Influence Of Sex Hormones On Cardiovascular Risk In Pcosmentioning

confidence: 95%

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

et al. 2015

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Currently, ≈1 in 13 people living in the United States has DM, and 90% to 95% of these individuals have type 2 DM (T2DM).2 Overall, the prevalence of T2DM is similar in women and men. In the United States, ≈12.6 million women (10.8%) and 13 million men (11.8%) ≥20 years of age are currently estimated to have T2DM. 2 Among individuals with T2DM, cardiovascular disease (CVD) is the leading cause of morbidity and mortality and accounts for >75% of hospitalizations and >50% of all deaths.3 Although nondiabetic women have fewer cardiovascular events than nondiabetic men of the same age, this advantage appears to be lost in the context of T2DM. 4,5 The reasons for this advantage are not entirely clear but are likely multifactorial with contributions from inherent physiological differences, including the impact of the sex hormones, differences in cardiovascular risk factors, and differences between the sexes in the diagnosis and treatment of DM and CVD. 6 In addition, there are racial and ethnic factors to consider because women of ethnic minority backgrounds have a higher prevalence of DM than non-Hispanic white (NHW) women.This scientific statement was designed to provide the current state of knowledge about sex differences in the cardiovascular consequences of DM, and it will identify areas that would benefit from further research because much is still unknown about sex differences in DM and CVD. Areas that are discussed include hormonal differences between the sexes and their possible effects on the interaction between DM and CVD, sex differences in epidemiology, ethnic and racial differences and risk factors for CVD in DM across the life span, sex differences in various types of CVD and heart failure, and sex differences in the effects of treatments for DM, including both medications and lifestyle. In addition, there is discussion about risk factors that are specific to women, including gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS), which affect CVD risk. Table 1 focuses on sex differences in CVD risk factors and outcomes in DM, and Table 2 provides information about sex differences in CVD treatments and interventions in DM. Table 3 contains some of the important ideas for research in sex differences in the cardiovascular consequences of DM. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 31, 2015, and the American Heart Association Executive Committee on September 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By...

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“…Endothelial dysfunction was shown to be associated with higher levels of androgens and with insulin resistance (202). This was observed even at very early ages, and with a trend of deterioration of endothelial function from lean to overweight and obese PCOS women (203). A recent systematic review of the studies has confirmed that C-IMT was thicker in women with PCOS in comparison with controls (204).…”

Section: Subclinical CV Disease In Pcosmentioning

confidence: 99%

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

576

492

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Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.

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Predictors of Endothelial Dysfunction in Young Women with Polycystic Ovary Syndrome

Cited by 165 publications

References 42 publications

Influence of spironolactone treatment on endothelial function in non-obese women with polycystic ovary syndrome

Influence of spironolactone treatment on endothelial function in non-obese women with polycystic ovary syndrome

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

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