Department of Cardiology, Erciyes University, Kayseri, Turkey.
Clin Endocrinol (Oxf). 2012 Dec;77(6):885-92. doi: 10.1111/j.1365-2265.2012.04436.x.
Polycystic ovary syndrome (PCOS) is a heterogeneous clinical condition. Oral contraceptive pills (OCPs) have conventionally been the mainstay of treatment for the amelioration of hyperandrogenism and regulation of menstrual cycles in women with PCOS. Metformin has beneficial effects on insulin resistance and endothelial functions. To our knowledge, the effect of metformin/OCP combination treatment on aortic stiffness has not been studied so far.
The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl oestradiol (E/E) alone or in combination with metformin on the elastic properties of the aorta in women with PCOS.
Thirty-seven women with PCOS were enrolled in the study. The first treatment arm, which was treated with OCP alone, was described as the OCP group (19 patients, mean age: 23·2 ± 5·4); the other treatment arm, which was treated with OCP and metformin, was described as the combination group (18 patients, mean age: 23·0 ± 4·5). The elastic parameters of the aorta namely 'aortic strain', 'aortic distensibility', 'aortic diameter alteration' and 'aortic stiffness index' were calculated by the appropriate formulae. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months of treatment, echocardiographic measurements and laboratory tests were also obtained.
After 6 months of treatment, significant weight loss and decrease in body mass index (BMI) were observed in the combination group (75·3 ± 13·3 kg to 72·3 ± 13·5 kg and 31·7 ± 7·3 kg/m² vs 30·4 ± 7·3 kg/m², P = 0·001 and P = 0·001, respectively). Conversely in the OCP group, BMI and weight were not significantly different after 6 months of treatment (68·8 ± 18·3 kg to 71·6 ± 21·2 kg and 26·4 ± 6·2 kg/m² to 27·4 ± 6·9 kg/m², P = 0·159 and P = 0·149, respectively). In addition, there were no significant differences in aortic strain, distensibility (7·7 ± 4·2 to 7·8 ± 3·6 and 7·2 ± 4·1 to 7·7 ± 3·6, P = 0·926 and P = 0·593, respectively) and stiffness index in the OCP group (8·8 ± 7·4 to 8·2 ± 6·7, P = 0·772). However, in the combination group, the adjusted values of the aortic stiffness index decreased significantly at the 6 months' follow-up (10·0 ± 1·5 to 6·7 ± 0·3, P = 0·021) and aortic distensibility and strain increased but not significantly (7·0 ± 4·3 to 9·3 ± 3·3 and 6·8 ± 3·9 to 9·4 ± 3·5, P = 0·163 and P = 0·071, respectively) at the 6 months' follow-up.
We demonstrated an improvement in the elastic parameters of the aorta by adding metformin to OCP treatment. We suggest that metformin plus OCP treatment may decrease cardiovascular disease risk in women with PCOS.
多囊卵巢综合征（PCOS）是一种异质性临床疾病。口服避孕药（OCP）传统上一直是改善高雄激素血症和调节 PCOS 妇女月经周期的主要治疗方法。二甲双胍对胰岛素抵抗和血管内皮功能有有益的影响。据我们所知，二甲双胍/OCP 联合治疗对主动脉僵硬度的影响尚未得到研究。
本研究旨在探讨单独使用屈螺酮/炔雌醇（E/E）或联合二甲双胍治疗对 PCOS 妇女主动脉弹性的影响。
纳入 37 名 PCOS 女性患者。第一组治疗为 OCP 单独治疗，称为 OCP 组（19 例，平均年龄：23.2 ± 5.4 岁）；另一组治疗为 OCP 和二甲双胍联合治疗，称为联合组（18 例，平均年龄：23.0 ± 4.5 岁）。通过适当的公式计算主动脉弹性参数，即“主动脉应变”、“主动脉扩张性”、“主动脉直径变化”和“主动脉僵硬度指数”。两组均研究了激素谱、HOMA-IR 评分、基础胰岛素和血糖水平。在治疗 6 个月前后，还进行了超声心动图测量和实验室检查。
治疗 6 个月后，联合组体重明显减轻，体重指数（BMI）降低（75.3 ± 13.3kg 降至 72.3 ± 13.5kg 和 31.7 ± 7.3kg/m² 降至 30.4 ± 7.3kg/m²，P = 0.001 和 P = 0.001）。相反，在 OCP 组中，治疗 6 个月后 BMI 和体重没有显著差异（68.8 ± 18.3kg 至 71.6 ± 21.2kg 和 26.4 ± 6.2kg/m² 至 27.4 ± 6.9kg/m²，P = 0.159 和 P = 0.149）。此外，OCP 组主动脉应变、扩张性（7.7 ± 4.2 至 7.8 ± 3.6 和 7.2 ± 4.1 至 7.7 ± 3.6，P = 0.926 和 P = 0.593）和僵硬度指数（8.8 ± 7.4 至 8.2 ± 6.7，P = 0.772）无显著差异。然而，在联合组中，主动脉僵硬度指数的调整值在 6 个月的随访中显著降低（10.0 ± 1.5 至 6.7 ± 0.3，P = 0.021），主动脉扩张性和应变增加但不显著（7.0 ± 4.3 至 9.3 ± 3.3 和 6.8 ± 3.9 至 9.4 ± 3.5，P = 0.163 和 P = 0.071）在 6 个月的随访中。
我们证明了在 OCP 治疗中加入二甲双胍可以改善主动脉的弹性参数。我们建议二甲双胍联合 OCP 治疗可能会降低 PCOS 女性的心血管疾病风险。
