Cardiovascular risk markers in polycystic ovary syndrome in women with and without insulin resistance

OBJETIVO: avaliar se a presença de resistência à insulina (RI) modifica fatores de risco cardiovascular em mulheres com síndrome dos ovários policísticos (SOP). MÉTODOS: estudo transversal no qual 60 mulheres com SOP, com idade entre 18 e 35 anos e sem uso de hormônios, foram avaliadas. A RI foi avaliada por meio do quantitative insulin sensitivity check index (QUICKI). RI foi definida como QUICKI <0,33. As seguintes variáveis foram comparadas entre o grupo com e sem RI: antropométricas (peso, altura, circunferência da cintura, pressão arterial e frequência cardíaca), laboratoriais (homocisteína, interleucina-6, fator de necrose tumoral-&#945;, testosterona, fração de androgênios livre, colesterol total e frações, triglicerídeos, proteína C reativa e insulina, glicose) e ultrassonográficas (distensibilidade e espessura íntima-média da carótida e dilatação mediada por fluxo da artéria braquial). RESULTADOS: Dezoito mulheres (30%) apresentaram RI. As mulheres com RI, comparadas às sem RI, apresentaram diferenças significativas nos seguintes marcadores antropométricos (SOP com RI e sem RI respectivamente): índice de massa corporal (35,5±5,6 versus 23,9±4,8 kg/m², p<0,01;), cintura (108,1±11,53 versus 79,5±11,1 cm, p<0,01) e pressão arterial sistólica (128,0±10,8 versus 114,0±8,9 mmHg, p<0,01) e pressão arterial diastólica (83,6±9,6 versus 77,0±7,5 mmHg, p=0,01). Também foram observadas diferenças significativas nos seguintes marcadores laboratoriais: triglicerídeos (120,0±56,5 versus 77,7±53,4 mg/dL, p=0,01), HDL (43,06±6,3 versus 40,4±10,8, p=0,01) e proteína C reativa (7,9±10,5 mg/L versus 2,6±3,2 mg/L, p<0,01), insulina (28,0±18,1 versus 5,3±2,4 µU/mL, p<0,01) e glicose (93,5±10,0 versus 87,5±8,7 mg/dL, p=0,02). Adicionalmente, dois dos três marcadores ultrassonográficos de risco cardiovascular também foram diferentes entre os grupos: distensibilidade carotídea (0,24±0,05 versus 0,30±0,08 mmHg-1, p<0,01) e espessura íntima-média da carótida (0,52±0,08 versus 0,43±0,09 mm, p<0,01). Além disso, a proporção de síndrome metabólica foi maior nas mulheres com RI (nove casos=50% versus três casos=7,1%, p<0,01). CONCLUSÕES: mulheres com SOP e RI apresentam diferenças significativas em vários marcadores ultrassonográficos, séricos e antropométricos que apontam para uma elevação no risco cardiovascular, quando comparadas a mulheres com SOP sem RI. Diante desses dados, a determinação sistemática da avaliação de RI em mulheres com SOP pode ajudar a identificar pacientes de risco cardiovascular.PURPOSE: to evaluate whether the presence of insulin resistance (IR) alters cardiovascular risk factors in women with polycystic ovary syndrome (POS). METHODS: transversal study where 60 POS women with ages from 18 to 35 years old, with no hormone intake, were evaluated. IR was assessed through the quantitative insulin sensitivity check index (QUICKI) and defined as QUICKI <0.33. The following variables have been compared between the groups with or without IR: anthropometric (weight, height, waist circumference, arterial blood pressure, cardiac frequency), laboratorial (homocysteine, interleucines-6, factor of tumoral-&#945; necrosis, testosterone, fraction of free androgen, total cholesterol and fractions, triglycerides, C reactive protein, insulin, glucose), and ultrasonographical (distensibility and carotid intima-media thickness, dilation mediated by the brachial artery flux). RESULTS: Eighteen women (30%) presented IR and showed significant differences in the following anthropometric markers, as compared to the women without IR (POS with and without IR respectively): body mass index (35.56±5.69 kg/m² versus 23.90±4.88 kg/m², p<0.01), waist (108.17±11.53 versus 79.54±11.12 cm, p<0.01), systolic blood pressure (128.00±10.80 mmHg versus 114.07±8.97 mmHg, p<0.01), diastolic blood pressure (83.67±9.63 mmHg versus 77.07±7.59 mmHg, p=0.01). It has also been observed significant differences in the following laboratorial markers: triglycerides (120.00±56.53 mg/dL versus 77.79±53.46 mg/dL, p=0.01), HDL (43.06±6.30 mg/dL versus 40.45±10.82 mg/dL, p=0.01), reactive C protein (7.98±10.54 mg/L versus 2.61±3.21 mg/L, p<0.01), insulin (28.01±18.18 µU/mL versus 5.38±2.48 µU/mL, p<0.01), glucose (93.56±10.00 mg/dL versus 87.52±8.75 mg/dL, p=0.02). Additionally, two out of the three ultrasonographical markers of cardiovascular risk were also different between the groups: carotid distensibility (0.24±0.05 mmHg-1 versus 0.30±0.08 mmHg-1, p<0.01) and carotid intima-media thickness (0.52±0.08 mm versus 0.43±0.09, p<0.01). Besides, the metabolic syndrome ratio was higher in women with IR (nine cases=50% versus three cases=7.1%, p<0.01). CONCLUSIONS: POS and IR women present significant differences in several ultrasonographical, seric and anthropometric markers, which point out to higher cardiovascular risk, as compared to women without POS and IR. In face of that, the systematic IR evaluation in POS women may help to identify patients with cardiovascular risk

Obesity and altered arterial structure in young women with micropolycystic ovary syndrome

OBJETIVO: comparar os fatores ecográficos de risco cardiovascular em pacientes obesas e não obesas, com síndrome dos ovários micropolicísticos (SOMP). MÉTODOS: foram incluídas 30 pacientes obesas com SOMP (Índice de massa corporal, IMC>30 kg/m²) e 60 não obesas (IMC<30 kg/m²), com idade entre 18 e 35 anos neste estudo transversal. Foram avaliados: a dilatação mediada por fluxo (DMF) da artéria braquial, espessura íntima-média da artéria carótida (IMT), o índice de rigidez da artéria carótida (&#946;), as medidas antropométricas, pressão sanguínea sistólica (PAS) e diastólica (PAD). As mulheres estavam sem nenhum tratamento prévio e nenhuma delas apresentava qualquer comorbidade (além da SOMP e/ou da obesidade).Na análise estatística, foram utilizados os testes t não-pareado ou de Mann-Whitney. RESULTADOS: as pacientes obesas com SOMP apresentaram maior peso em relação às não obesas (92,1±11,7 kg versus 61,4±10,7 kg, p<0,0001), bem como a medida da cintura que também, foi mais elevada nas pacientes obesas (105,0±10,4 cm versus 78,5±9,8 cm, p<0,0001). A PAS das pacientes obesas foi superior quando comparadas às não obesas (126,1±10,9 mmHg versus 115,8±9,0 mmHg, p<0,0001) e a IMT também foi maior nas obesas (0,51±0,07 mm versus 0,44±0,09 mm, p<0,0001). Não houve diferença entre os grupos quanto à dilatação mediada por fluxo (DMF) da artéria braquial ou ao índice de rigidez da artéria carótida (&#946;). CONCLUSÕES: a obesidade em portadoras jovens de SOMP está associada a níveis pressóricos mais elevados e à alteração da estrutura arterial, representada pela maior espessura íntima-média da artéria carótida.PURPOSE: to compare echographical cardiovascular risk factors between obese and non-obese patients with micropolycystic ovarian syndrome (MPOS). METHODS: in this transversal study, 30 obese (Body Mass Index, BMI>30 kg/m²) and 60 non-obese (BMI<30 kg/m²) MPOS patients, aging between 18 and 35 years old, were included. The following variables were measured: flow-mediated dilatation (FMD) of the brachial artery, thickness of the intima-media of the carotid artery (IMT), anthropometric data, systolic arterial pressure (SAP) and diastolic arterial pressure (DAP). The women had no previous medical treatment and no comorbidity besides MPOS and obesity. For statistical analysis, the non-paired tand Mann-Whitney's tests were used. RESULTS: obese weighted more than non-obese patients (92.1±11.7 kg versus 61.4±10.7 kg, p<0.0001) and had a larger waist circumference (105.0±10.4 cm versus 78.5±9.8 cm, p<0.0001). The SBP of obese patients was higher than that of the non-obese ones (126.1±10.9 mmHg versus 115.8±9.0 mmHg, p<0.0001) and the IMT was also bigger (0.51±0.07 mm versus 0.44±0.09 mm, p<0.0001). There was no significant difference between the groups as to FMD and carotid rigidity index (&#946;). CONCLUSIONS: obesity in young women with MPOS is associated with higher blood pressure and alteration of arterial structure, represented by a thicker intima-media of the carotid artery

Early markers of cardiovascular disease in women with polycystic ovary syndrome

Introdução:A síndrome dos ovários policísticos (SOP) é a endocrinopatia mais comum em mulheres no menacme, com prevalência variando de 5 a 10%. A SOP está associada à elevação do risco cardiovascular e eventos metabólicos adversos, incluindo obesidade, resistência à insulina, dislipidemia e inflamação crônica de baixo grau. Apesar dos fatores de risco cardiovascular serem mais prevalentes em mulheres com SOP, não existe evidência científica de maior incidência de doença cardiovascular (DCV) nestas mulheres. Vários estudos reportaram alterações em marcadores de risco para DCV na SOP, porém ainda não foram determinados quais os marcadores ideais para a detecção precoce da DCV. Objetivo:Avaliar a presença de marcadores precoces de DCV em mulheres jovens e não-obesas com SOP. Casuística e Métodos:Foram incluídas 39 pacientes com SOP e 50 mulheressaudáveis, com ciclos menstruais regulares e pareadas por idade e índice de massa corporal (IMC). Através da ultra-sonografia foram avaliados os seguintes marcadores de DCV: índice de rigidez da artéria carótida comum, distensibilidade da artéria carótida comum, espessura da camada íntima-média da artéria carótida comum (IMT) e dilatação mediada pelo fluxo da artéria braquial (DMF). Foram avaliadas ainda variáveis antropométricas, hormonais e marcadores de inflamação em todas as participantes. Resultados: A idade e o IMC nas mulheres com SOP não apresentaram diferença quando comparados às mulheres do grupo controle (24,5 ± 3,80 vs 24,5 ± 5,1, 0,6, respectivamente).O índice de rigidez da carótida comum foi mais elevado no grupo SOP comparado ao grupo controle (3.6 ± 0.96 vs 3.1 ± 0.96, p= 0.04, respectivamente) e a distensibilidade da artéria carótida comum foi menor nas pacientes com SOP em comparação àquelas do grupo controle (0.3 ± 0.08 vs 0.4 ± 0.09, p=0.02, respectivamente). As pacientes com SOP apresentaram maior circunferência da cintura, testosterona total e free androgen index(FAI) em relação ao grupo controle (78.2 +10.0 vs 71.6 +7.2, p= 0,0004; 85.0 +32.4 vs 52.0 +21.3, p<0.0001 e 8.9 +28.7 vs 4.4 +2.3, p<0.0001, respectivamente), enquanto a sex hormone binding globulin(SHBG) mostrou-se reduzida na SOP quando comparadaao grupo controle (37.8 +19.1 vs 47.8 +18.3, p=0.01). As demais variáveis não diferiram entre os dois grupos. Conclusão: Nosso estudo demonstra que mulheres jovens com SOP apresentam alterações na elasticidade vascular mesmo na ausência de clássicos fatores de risco para DCV, como: resistência à insulina, hipertensão ou obesidade.Introduction: The polycystic ovary syndrome (PCOS) is a common endocrine disease affecting 5% to 10% of women of reproductive age. PCOS is associated with an adverse metabolic and cardiovascular risk profile, including obesity, insulin resistance, dyslipidemia and low-grade chronic inflammation. Although cardiovascular risk factors are more prevalent in women with PCOS, definitive evidence for an increased incidence of cardiovascular disease (CVD) is lacking. Several studies reported disorders in markers of CVD in PCOS patients, however they were not still certain whichare the best subclinical markers of CVD in these young women. Objective:To evaluate the early markers of CVD in young PCOSwomen. Material and Methods:Thirty nine PCOS women and 50 healthy age and bodymass index (BMI)-matched ovulatory controls were enrolled in this cross-sectional study. Carotid stiffness index (?), carotid compliance, Carotid intima-media thickness (IMT) and brachial arterial flow-mediated dilation (FMD) were measuredby ultrasonography. Anthropometric measurements, complete hormonal and metabolic (including inflammatory biomarkers) evaluation were done in all subjects. Results: ?was significantly higher in PCOS subjects than in healthy controls (3.7 ± 0.96 vs 3.3 ± 0.96, p= 0.04, respectively) and carotid compliance was lower in PCOS than in healthy controls (0.3 ± 0.08 vs 0.4 ± 0.09, p=0.02 respectively). PCOS patients also present elevated WC, total testosterone and free androgen index compared to control group (78.2 +10.0 vs 71.2 +7.2, p= 0,0004; 86.2 +32.1 vs 57.4 +21.2, p<0.0001 and 12.7 +15.7 vs 4.7 +2.4, p<0.0001. respectively). The sex hormone biding globulin was lower in PCOS women than in control group (37.3 +19.2 vs 47.8 +18.3, p=0.01). The other variables did not differ between the groups. Conclusions: Comparing to non-obese ovulatory controls, non-obese PCOS patients present impaired elastic properties in carotid artery, thatcould reflect vascular dysfunction associated with PCOS. However, endothelial function and inflammatory biomarkers remain unaffected

Early markers of cardiovascular disease in women with polycystic ovary syndrome

Introdução:A síndrome dos ovários policísticos (SOP) é a endocrinopatia mais comum em mulheres no menacme, com prevalência variando de 5 a 10%. A SOP está associada à elevação do risco cardiovascular e eventos metabólicos adversos, incluindo obesidade, resistência à insulina, dislipidemia e inflamação crônica de baixo grau. Apesar dos fatores de risco cardiovascular serem mais prevalentes em mulheres com SOP, não existe evidência científica de maior incidência de doença cardiovascular (DCV) nestas mulheres. Vários estudos reportaram alterações em marcadores de risco para DCV na SOP, porém ainda não foram determinados quais os marcadores ideais para a detecção precoce da DCV. Objetivo:Avaliar a presença de marcadores precoces de DCV em mulheres jovens e não-obesas com SOP. Casuística e Métodos:Foram incluídas 39 pacientes com SOP e 50 mulheressaudáveis, com ciclos menstruais regulares e pareadas por idade e índice de massa corporal (IMC). Através da ultra-sonografia foram avaliados os seguintes marcadores de DCV: índice de rigidez da artéria carótida comum, distensibilidade da artéria carótida comum, espessura da camada íntima-média da artéria carótida comum (IMT) e dilatação mediada pelo fluxo da artéria braquial (DMF). Foram avaliadas ainda variáveis antropométricas, hormonais e marcadores de inflamação em todas as participantes. Resultados: A idade e o IMC nas mulheres com SOP não apresentaram diferença quando comparados às mulheres do grupo controle (24,5 ± 3,80 vs 24,5 ± 5,1, 0,6, respectivamente).O índice de rigidez da carótida comum foi mais elevado no grupo SOP comparado ao grupo controle (3.6 ± 0.96 vs 3.1 ± 0.96, p= 0.04, respectivamente) e a distensibilidade da artéria carótida comum foi menor nas pacientes com SOP em comparação àquelas do grupo controle (0.3 ± 0.08 vs 0.4 ± 0.09, p=0.02, respectivamente). As pacientes com SOP apresentaram maior circunferência da cintura, testosterona total e free androgen index(FAI) em relação ao grupo controle (78.2 +10.0 vs 71.6 +7.2, p= 0,0004; 85.0 +32.4 vs 52.0 +21.3, p<0.0001 e 8.9 +28.7 vs 4.4 +2.3, p<0.0001, respectivamente), enquanto a sex hormone binding globulin(SHBG) mostrou-se reduzida na SOP quando comparadaao grupo controle (37.8 +19.1 vs 47.8 +18.3, p=0.01). As demais variáveis não diferiram entre os dois grupos. Conclusão: Nosso estudo demonstra que mulheres jovens com SOP apresentam alterações na elasticidade vascular mesmo na ausência de clássicos fatores de risco para DCV, como: resistência à insulina, hipertensão ou obesidade.Introduction: The polycystic ovary syndrome (PCOS) is a common endocrine disease affecting 5% to 10% of women of reproductive age. PCOS is associated with an adverse metabolic and cardiovascular risk profile, including obesity, insulin resistance, dyslipidemia and low-grade chronic inflammation. Although cardiovascular risk factors are more prevalent in women with PCOS, definitive evidence for an increased incidence of cardiovascular disease (CVD) is lacking. Several studies reported disorders in markers of CVD in PCOS patients, however they were not still certain whichare the best subclinical markers of CVD in these young women. Objective:To evaluate the early markers of CVD in young PCOSwomen. Material and Methods:Thirty nine PCOS women and 50 healthy age and bodymass index (BMI)-matched ovulatory controls were enrolled in this cross-sectional study. Carotid stiffness index (?), carotid compliance, Carotid intima-media thickness (IMT) and brachial arterial flow-mediated dilation (FMD) were measuredby ultrasonography. Anthropometric measurements, complete hormonal and metabolic (including inflammatory biomarkers) evaluation were done in all subjects. Results: ?was significantly higher in PCOS subjects than in healthy controls (3.7 ± 0.96 vs 3.3 ± 0.96, p= 0.04, respectively) and carotid compliance was lower in PCOS than in healthy controls (0.3 ± 0.08 vs 0.4 ± 0.09, p=0.02 respectively). PCOS patients also present elevated WC, total testosterone and free androgen index compared to control group (78.2 +10.0 vs 71.2 +7.2, p= 0,0004; 86.2 +32.1 vs 57.4 +21.2, p<0.0001 and 12.7 +15.7 vs 4.7 +2.4, p<0.0001. respectively). The sex hormone biding globulin was lower in PCOS women than in control group (37.3 +19.2 vs 47.8 +18.3, p=0.01). The other variables did not differ between the groups. Conclusions: Comparing to non-obese ovulatory controls, non-obese PCOS patients present impaired elastic properties in carotid artery, thatcould reflect vascular dysfunction associated with PCOS. However, endothelial function and inflammatory biomarkers remain unaffected

Exercise and reproductive function in polycystic ovary syndrome: protocol of a systematic review

Abstract Background Although many post-participation outcomes in different types of physical training (e.g., aerobic and strength) have been previously investigated for the treatment of polycystic ovary syndrome, there is no recent systematic review of the relationship between various types of intervention and the reproductive function of women with PCOS. The current paper describes a systematic review protocol on the benefits of physical exercise and dietary or drug interventions on endocrinological outcomes in women with PCOS. Methods PubMed/MEDLINE, Science Direct, Bireme, Scopus, Web of Science, ProQuest, Cochrane Library (Cochrane Systematic Reviews Database, Cochrane Central Register of Controlled Studies (CENTRAL) databases will be searched. Studies randomized controlled trials reporting on intervening changes in exercise interventions with or without interventions compared such as diet, medication and acupuncture on the menstrual cycle, and fertility in women with PCOS will be included. Results will be on the decrease of the characteristics of hyperandrogenism, insulin resistance, and obesity. Studies published since 2010 and in the English language will be included. Discussion This systematic review will identify improvement strategies and types of interventions that are geared toward improving endocrine and consequently metabolic parameters. Thus, the use of such strategies may increase the types of low-cost non-drug therapies that aid in the treatment of PCOS. Systematic review registration PROSPERO CRD4201705886

Both a combined oral contraceptive and depot medroxyprogesterone acetate impair endothelial function in young women

Background: The study was conducted to determine whether the use of a combined oral contraceptive (COC) or depot medroxyprogesterone acetate (DMPA) interferes with endothelial function. Study Design: The study was conducted on 100 women between the ages of 18 and 30 years. Fifty women had not used hormonal contraception (control group) for at least 12 months, 25 were current users of a COC (ethinylestradiol 30 mcg+levonorgestrel 150 mcg) and 25 were current users of DMPA (150 mg) for at least a 6-month period. All women were evaluated for brachial flow-mediated dilation (FMD), intima-media thickness, carotid distensibility and stiffness index, arterial pressure, body mass index, waist circumference, heart rate and lipid profile. Results: A significant difference in FMD was observed between the COC and control groups (6.4 +/- 2.2% vs. 8,7 +/- 3.4%, p<.01) and between the DMPA and control groups (6.2 +/- 2.1% vs. 8.7 +/- 3.4%, p<.01). The DMPA group had lower values of total cholesterol (TC) and low-density lipoprotein (LDL-C) than COC users and the control group (TC: DMPA=139.9 +/- 21.5 mg/dL vs. controls=167.1 +/- 29.2 mg/dL vs. COC=168.2 +/- 37.5. p=.001; LDL-C: DMPA-85.3 +/- 20.1 mg/dL vs. controls=102 +/- 24.5 mg/dL vs. COC=106.7 +/- 33.3 mg/dL, p=.01). The control group had higher levels of high-density lipoprotein (HDL-C) than the DMPA and COC groups (controls=52.4 +/- 14.1 mg/dL vs. DMPA=42.2 +/- 7.2 mg/dL vs. COC=45.4 +/- 9.1 mg/dL, p=.001). No significant differences were observed regarding the other variables. Conclusions: FMD was lower among COC and DMPA users, Suggesting that these hormonal contraceptives may promote endothelial dysfunction. (C) 2009 Elsevier Inc. All rights reserved.Human Reproduction Division of the Department of Gynaecology and Obstetrics of the University of Sao Paulo Ribeirao Preto School of Medicine (USP), Ribeirao Preto, Brazi

The effects of 2 mg chlormadinone acetate/30 mcg ethinylestradiol, alone or combined with spironolactone, on cardiovascular risk markers in women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder associated with metabolic dysfunction and changes in cardiovascular risk markers, and using oral contraceptives (OCs) may exert a further negative effect on these alterations in patients with PCOS. Thus, the primary objective of this study was to assess the effects on arterial function and structure of an OC containing chlormadinone acetate (2 mg) and ethinylestradiol (30 mcg), alone or combined with spironolactone (OC+SPL), in patients with PCOS. Study Design: This was a randomized, controlled clinical trial. Fifty women with PCOS between 18 and 35 years of age were randomized by a computer program to use OC or OC+SPL. Brachial artery flow-mediated vasodilation, carotid intima-media thickness and the carotid artery stiffness index were evaluated at baseline and after 6 and 12 months. Serum markers for cardiovascular disease were also analyzed. The intragroup data were analyzed using analysis of variance with Tukey's post hoc test. A multivariate linear regression model was used to analyze the intergroup data. Results: At 12 months, the increase in mean total cholesterol levels was greater in the OC+SPL group than in the OC group (27% vs. 13%, respectively; p=.02). The increase in mean sex hormone-binding globulin levels was greater in the OC group than in the OC+SPL group (424% vs. 364%, respectively; p=.01). No statistically significant differences between the groups were found for any of the other variables. Conclusion: The addition of spironolactone to an OC containing chlormadinone acetate and ethinylestradiol conferred no cardiovascular risk-marker advantages in young women with PCOS. (C) 2012 Elsevier Inc. All rights reserved.Waldemar B. Pessoa FoundationWaldemar B. Pessoa FoundationNational Institute of Hormones and Womens Health, National Council for Scientific and Technological Development (CNPq)National Institute of Hormones and Women's Health, National Council for Scientific and Technological Development (CNPq