Statins for women with polycystic ovary syndrome not actively trying to conceive

Raval, Amit D.; Hunter, Tamara; Stuckey, Bronwyn; Hart, Roger

doi:10.1002/14651858.cd008565.pub2

Cited by 37 publications

(24 citation statements)

References 59 publications

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“…Furthermore, statins appear to have antioxidant properties. Clinical trials of statins alone or in combination with other medications among women with PCOS are limited in number, and conclusive evidence that statins ameliorate PCOS symptoms is lacking, although improvements in hyperandrogenemia have been noted (276, 279–281). Further recent data show that statin use may increase the risk for developing T2DM (282).…”

Section: Methods Of Development Of Evidence-based Clinical Practice Gumentioning

confidence: 99%

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

Legro

Arslanian

Ehrmann

et al. 2013

The Journal of Clinical Endocrinology & Metabolism

1,555

1,346

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Objective:The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).Participants:An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline.Evidence:This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.Consensus Process:One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence.Conclusions:We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing a diagnosis of PCOS is problematic in adolescents and menopausal women. Hyperandrogenism is central to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausal women. Evaluation of women with PCOS should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS. Clomiphene is currently the first-line therapy for infertility; metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility. Hormonal contraceptives and metformin are the treatment options in adolescents with PCOS. The role of weight loss in improving PCOS status per se is uncertain, but lifestyle intervention is beneficial in overweight/obese patients for other health benefits. Thiazolidinediones have an unfavorable risk-benefit ratio overall, and statins require further study.

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Section: Methods Of Development Of Evidence-based Clinical Practice Gumentioning

confidence: 99%

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

Legro

Arslanian

Ehrmann

et al. 2013

The Journal of Clinical Endocrinology & Metabolism

1,555

1,346

View full text Add to dashboard Cite

show abstract

“…Nevertheless, statins have recently been discovered as an effective anti-androgen treatment for polycystic ovary syndrome [25,35]. A recent meta-analysis of statin therapy for women with polycystic ovary syndrome concluded that statins reduced testosterone based on the same literature [36]. …”

Section: Discussionmentioning

confidence: 99%

The effect of statins on testosterone in men and women, a systematic review and meta-analysis of randomized controlled trials

Schooling

Yeung

Freeman

et al. 2013

BMC Med

190

135

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BackgroundStatins are extensively used for cardiovascular disease prevention. Statins reduce mortality rates more than other lipid-modulating drugs, although evidence from randomized controlled trials also suggests that statins unexpectedly increase the risk of diabetes and improve immune function. Physiologically, statins would be expected to lower androgens because statins inhibit production of the substrate for the local synthesis of androgens and statins' pleiotropic effects are somewhat similar to the physiological effects of lowering testosterone, so we hypothesized that statins lower testosterone.MethodsA meta-analysis of placebo-controlled randomized trials of statins to test the a priori hypothesis that statins lower testosterone. We searched the PubMed, Medline and ISI Web of Science databases until the end of 2011, using '(Testosterone OR androgen) AND (CS-514 OR statin OR simvastatin OR atorvastatin OR fluvastatin OR lovastatin OR rosuvastatin OR pravastatin)' restricted to randomized controlled trials in English, supplemented by a bibliographic search. We included studies with durations of 2+ weeks reporting changes in testosterone. Two reviewers independently searched, selected and assessed study quality. Two statisticians independently abstracted and analyzed data, using random or fixed effects models, as appropriate, with inverse variance weighting.ResultsOf the 29 studies identified 11 were eligible. In 5 homogenous trials of 501 men, mainly middle aged with hypercholesterolemia, statins lowered testosterone by -0.66 nmol/l (95% confidence interval (CI) -0.14 to -1.18). In 6 heterogeneous trials of 368 young women with polycystic ovary syndrome, statins lowered testosterone by -0.40 nmol/l (95% CI -0.05 to -0.75). Overall statins lowered testosterone by -0.44 nmol/l (95% CI -0.75 to -0.13).ConclusionsStatins may partially operate by lowering testosterone. Whether this is a detrimental side effect or mode of action warrants investigation given the potential implications for drug development and prevention of non-communicable chronic diseases.See commentary article here http://www.biomedcentral.com/1741-7015/11/58

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“…203 Furthermore, the effects of statins on a number of other clinical conditions have been evaluated, including dementia, 204 hepatic steatosis, 205 cancer, 206,207 venous thromboembolism 208 and polycystic ovary syndrome. 209 Available data are controversial and thus far no clinically relevant effect on these conditions has been demonstrated. Statins also reduce TGs by 30 -50% and may increase HDL-C by 5 -10%.…”

Section: Efficacy Of Cardiovascular Disease Prevention In Clinical Stmentioning

confidence: 99%

ESC/EAS Guidelines for the management of dyslipidaemias

Catapano¹,

Reiner²,

Backer³

et al. 2011

Atherosclerosis

565

189

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Statins for women with polycystic ovary syndrome not actively trying to conceive

Cited by 37 publications

References 59 publications

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

The effect of statins on testosterone in men and women, a systematic review and meta-analysis of randomized controlled trials

ESC/EAS Guidelines for the management of dyslipidaemias

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