Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA.
Kar Clinic and Hospital, Orissa, India.
Am J Obstet Gynecol. 2017 Aug;217(2):189.e1-189.e8. doi: 10.1016/j.ajog.2017.04.007. Epub 2017 Apr 8.
Polycystic ovary syndrome is a heterogeneous disorder and its presentation varies with race and ethnicity. Reproductive-age women with polycystic ovary syndrome are at increased risk of metabolic syndrome; however, it is not clear if prevalence of metabolic syndrome and clustering of its components differs based on race and ethnicity. Moreover, the majority of these women do not undergo routine screening for metabolic syndrome.
We sought to compare the prevalence of metabolic syndrome and clustering of its components in women with polycystic ovary syndrome in the United States with women in India, Brazil, Finland, and Norway.
This is a cross-sectional study performed in 1089 women with polycystic ovary syndrome from 1999 through 2016 in 5 outpatient clinics in the United States, India, Brazil, Finland, and Norway. Polycystic ovary syndrome was defined by the Rotterdam criteria. Main outcome measures were: metabolic syndrome prevalence, blood pressure, body mass index, fasting high-density lipoprotein cholesterol, fasting triglycerides, and fasting glucose. Data from all sites were reevaluated for appropriate application of diagnostic criteria for polycystic ovary syndrome, identification of polycystic ovary syndrome phenotype, and complete metabolic workup. The US White women with polycystic ovary syndrome were used as the referent group. Logistic regression models were used to evaluate associations between race and metabolic syndrome prevalence and its components and to adjust for potential confounders, including age and body mass index.
The median age of the entire cohort was 28 years. Women from India had the highest mean Ferriman-Gallwey score for clinical hyperandrogenism (15.6 ± 6.5, P < .001). The age-adjusted odds ratio for metabolic syndrome was highest in US Black women at 4.52 (95% confidence interval, 2.46-8.35) compared with US White women. When adjusted for age and body mass index, the prevalence was similar in the 2 groups. Significantly more Black women met body mass index and blood pressure criteria (P < .001), and fewer met fasting triglycerides criteria (P < .05). The age- and body mass index-adjusted prevalence of metabolic syndrome was highest in Indian women (odds ratio, 6.53; 95% confidence interval, 3.47-12.30) with abnormalities in glucose and fasting high-density lipoprotein cholesterol criterion and in Norwegian women (odds ratio, 2.16; 95% confidence interval, 1.17-3.98) with abnormalities in blood pressure, glucose, and fasting high-density lipoprotein cholesterol criterion. The Brazilian and Finnish cohorts had similar prevalence of metabolic syndrome and its components compared to US White women.
Despite a unifying diagnosis of polycystic ovary syndrome, there are significant differences in the prevalence of metabolic syndrome and clustering of its components based on race and ethnicity, which may reflect contributions from both racial and environmental factors. Our findings indicate the prevalence of metabolic syndrome components varies in women with polycystic ovary syndrome, such that compared to White women from the United States, Black US women had the highest prevalence, whereas women from India and Norway had a higher prevalence of metabolic syndrome independent of obesity. The differences in clustering of components of metabolic syndrome based on ethnicity highlight the need to routinely perform complete metabolic screening to identify specific targets for cardiovascular risk reduction strategies in these reproductive-age women.
多囊卵巢综合征是一种异质性疾病，其表现因种族和民族而异。患有多囊卵巢综合征的育龄妇女患代谢综合征的风险增加；然而，目前尚不清楚代谢综合征的患病率以及其成分的聚类是否因种族和民族而有所不同。此外，这些妇女中的大多数并没有接受代谢综合征的常规筛查。
我们旨在比较美国、印度、巴西、芬兰和挪威患有多囊卵巢综合征的妇女中代谢综合征的患病率以及其成分的聚类。
这是一项横断面研究，纳入了 1999 年至 2016 年期间美国、印度、巴西、芬兰和挪威的 5 家门诊诊所的 1089 例多囊卵巢综合征患者。多囊卵巢综合征的定义采用鹿特丹标准。主要结局指标为：代谢综合征患病率、血压、体重指数、空腹高密度脂蛋白胆固醇、空腹甘油三酯和空腹血糖。对所有地点的数据进行重新评估，以适当应用多囊卵巢综合征的诊断标准、识别多囊卵巢综合征表型和进行完整的代谢检查。美国白人多囊卵巢综合征妇女被用作参照组。使用 logistic 回归模型评估种族与代谢综合征患病率及其成分之间的关联，并调整潜在混杂因素，包括年龄和体重指数。
整个队列的中位年龄为 28 岁。印度妇女的临床高雄激素血症的平均 Ferriman-Gallwey 评分最高（15.6±6.5，P<0.001）。与美国白人妇女相比，美国黑人妇女的代谢综合征年龄调整比值比最高，为 4.52（95%置信区间，2.46-8.35）。调整年龄和体重指数后，两组的患病率相似。显著更多的黑人妇女符合体重指数和血压标准（P<0.001），而符合空腹甘油三酯标准的妇女较少（P<0.05）。印度妇女的代谢综合征年龄和体重指数调整后患病率最高（比值比，6.53；95%置信区间，3.47-12.30），其葡萄糖和空腹高密度脂蛋白胆固醇标准异常，挪威妇女的患病率也较高（比值比，2.16；95%置信区间，1.17-3.98），其血压、葡萄糖和空腹高密度脂蛋白胆固醇标准异常。巴西和芬兰队列的代谢综合征及其成分的患病率与美国白人妇女相似。
尽管多囊卵巢综合征的诊断具有一致性，但基于种族和民族，代谢综合征及其成分的患病率存在显著差异，这可能反映了种族和环境因素的共同作用。我们的研究结果表明，多囊卵巢综合征妇女的代谢综合征成分的患病率存在差异，与美国白人妇女相比，美国黑人妇女的患病率最高，而印度和挪威妇女的代谢综合征患病率则不受肥胖影响。基于种族的代谢综合征成分聚类的差异突出表明，需要常规进行完整的代谢筛查，以确定这些育龄妇女心血管风险降低策略的具体目标。
