Rizzo Manfredi, Berneis Kaspar, Carmina Enrico, Rini Giovam Battista
Department of Clinical Medicine and Emerging Diseases, University of Palermo, Palermo, Italy.
Am J Obstet Gynecol. 2008 Jan;198(1):28.e1-5. doi: 10.1016/j.ajog.2007.09.014.
Despite their young age, women with polycystic ovary syndrome (PCOS) have increased cardiovascular risk. Besides normal concentrations of low-density lipoprotein (LDL) cholesterol, dyslipidemia is very common and includes elevated triglyceride levels and low high-density lipoprotein cholesterol concentrations. Recent findings also showed that women with PCOS have qualitative LDL alterations, with increased levels of atherogenic small, dense LDL particles. Such lipid abnormalities constitute a common form of dyslipidemia, the so-called atherogenic lipoprotein phenotype (ALP), associated with a greater cardiovascular risk. Weight reduction and increased physical activity may constitute first-line therapy for ALP in PCOS, and lipid lowering drugs, particularly nicotinic acid and fibrates, should be used in patients with severe dyslipidemia. Statins have usually a lower impact on ALP, and their beneficial effect is often moderate. Insulin-sensitizing medications favorably alter each component of ALP and combined therapy with these agents remains an option; in particular, the combination pioglitazone plus metformin seems to be particularly beneficial.
尽管患有多囊卵巢综合征（PCOS）的女性较为年轻，但她们的心血管风险却有所增加。除了低密度脂蛋白（LDL）胆固醇浓度正常外，血脂异常非常普遍，包括甘油三酯水平升高和高密度脂蛋白胆固醇浓度降低。最近的研究结果还表明，患有PCOS的女性存在LDL的质量改变，致动脉粥样硬化的小而密LDL颗粒水平增加。这种脂质异常构成了血脂异常的一种常见形式，即所谓的致动脉粥样硬化脂蛋白表型（ALP），与更高的心血管风险相关。减轻体重和增加体力活动可能是PCOS中ALP的一线治疗方法，对于严重血脂异常的患者应使用降脂药物，特别是烟酸和贝特类药物。他汀类药物通常对ALP的影响较小，其有益作用往往适中。胰岛素增敏药物可有利地改变ALP的各个成分，与这些药物联合治疗仍是一种选择；特别是，吡格列酮加二甲双胍的联合用药似乎特别有益。
