Meyer C, McGrath B P, Teede H J
Monash University Department of Medicine, Dandenong Hospital, Melbourne, Victoria 3175, Australia.
J Clin Endocrinol Metab. 2005 Oct;90(10):5711-6. doi: 10.1210/jc.2005-0011. Epub 2005 Jul 26.
Polycystic ovary syndrome (PCOS) is associated with insulin resistance (IR) and the metabolic syndrome. There are no adequate data demonstrating significantly increased cardiovascular disease (CVD) mortality. In the absence of clinical outcome studies, surrogate markers of early CVD can provide insight into early CVD.
The aim of this study was to clarify whether overweight women with PCOS have an increased prevalence of cardiovascular risk factors and early CVD, compared with age- and body mass index-matched controls, to determine the contribution of PCOS per se to CVD status.
This was a case control study of 100 overweight women with PCOS and 20 subjects of similar body mass index and age.
Noninvasive markers of early CVD [carotid intimal media thickness, pulse wave velocity (PWV), and brachial arterial flow-mediated vasodilation] were measured. Metabolic parameters studied included insulin, glucose, C-reactive protein, lipids, and androgens.
Subjects with PCOS had elevated testosterone (2.5 +/- 0.2 vs. 1.3 +/- 0.1 nmol/liter), dehydroepiandrosterone sulfate (4.9 +/- 0.3 vs. 3.6 +/- 0.4 mmol/liter), fasting insulin (19.6 +/- 1.4 vs. 6.8 +/- 0.8 microU/ml), and homeostasis model assessment of IR (4.1 +/- 0.3 vs. 1.3 +/- 0.2), compared with controls. In addition, those with PCOS had elevated cholesterol (5.1 +/- 0.1 vs. 4.6 +/- 0.2 mmol/liter) and triglycerides (1.4 +/- 0.1 vs. 0.9 +/- 0.1 mmol/liter), whereas there were no differences in either C-reactive protein or 24-h ambulatory blood pressure parameters. Subjects with PCOS also had increased arterial stiffness (PWV, 7.4 +/- 0.1 vs. 6.6 +/- 0.2 m/sec) and endothelial dysfunction (flow-mediated vasodilation, 9.8 +/- 0.4 vs. 13.3 +/- 0.9), compared with controls. There was no difference in mean intimal media thickness between the groups. Stepwise regression in PCOS subjects showed that IR and lipids were independent predictors of PWV.
Overweight women with PCOS have increased cardiovascular risk factors and evidence of early CVD, compared with weight-matched controls, potentially related to IR.
多囊卵巢综合征（PCOS）与胰岛素抵抗（IR）及代谢综合征相关。目前尚无充分数据表明心血管疾病（CVD）死亡率显著增加。在缺乏临床结局研究的情况下，早期CVD的替代标志物可提供对早期CVD的深入了解。
本研究旨在阐明与年龄和体重指数匹配的对照组相比，超重的PCOS女性心血管危险因素及早期CVD的患病率是否增加，以确定PCOS本身对CVD状态的影响。
这是一项针对100名超重PCOS女性和20名体重指数及年龄相似的受试者的病例对照研究。
测量早期CVD的非侵入性标志物[颈动脉内膜中层厚度、脉搏波速度（PWV）和肱动脉血流介导的血管舒张功能]。研究的代谢参数包括胰岛素、血糖、C反应蛋白、血脂和雄激素。
与对照组相比，PCOS患者的睾酮水平升高（2.5±0.2 vs. 1.3±0.1 nmol/L）、硫酸脱氢表雄酮水平升高（4.9±0.3 vs. 3.6±0.4 mmol/L）、空腹胰岛素水平升高（19.6±1.4 vs. 6.8±0.8 μU/ml）以及IR的稳态模型评估值升高（4.1±0.3 vs. 1.3±0.2）。此外，PCOS患者的胆固醇（5.1±0.1 vs. 4.6±0.2 mmol/L）和甘油三酯（1.4±0.1 vs. 0.9±0.1 mmol/L）水平升高，而C反应蛋白或24小时动态血压参数无差异。与对照组相比，PCOS患者的动脉僵硬度也增加（PWV，7.4±0.1 vs. 6.6±0.2 m/sec），且存在内皮功能障碍（血流介导的血管舒张功能，9.8±0.4 vs. 13.3±0.9）。两组间平均内膜中层厚度无差异。PCOS患者的逐步回归分析显示，IR和血脂是PWV的独立预测因素。
与体重匹配的对照组相比，超重的PCOS女性心血管危险因素增加且有早期CVD的证据，这可能与IR有关。
