scholarly journals Young Obese Women with Polycystic Ovary Syndrome Have Evidence of Early Coronary Atherosclerosis

2007 ◽  
Vol 92 (12) ◽  
pp. 4609-4614 ◽  
Author(s):  
Rupal Shroff ◽  
Angela Kerchner ◽  
Michelle Maifeld ◽  
Edwin J. R. Van Beek ◽  
Dinesh Jagasia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Coronary Atherosclerosis ◽  
Polycystic Ovary ◽  
Fat Distribution ◽  
Obese Women ◽  
Ovary Syndrome ◽  
Markers Of Inflammation ◽  
Increased Risk

Abstract Context: Polycystic ovary syndrome (PCOS) is associated with comorbidities that may contribute to increased risk of cardiovascular disease. PCOS is associated with increased risk of metabolic syndrome, dyslipidemia, and diabetes, but it remains unclear whether traditional cardiovascular (CV) risk factors can help predict coronary artery disease in this population. Objective: The objectives of the study were to detect early-onset subclinical coronary atherosclerosis (using coronary artery calcium as a marker) in young women with PCOS, compared with age- and body mass index-matched controls, and to compare traditional CV risk factors and inflammatory markers in the two groups. Design: This was a prospective case-control study. Setting: The study was conducted at a university hospital. Subjects: Twenty-four obese (body mass index ≥ 30 kg/m2) PCOS subjects and 24 obese controls participated. Outcome Measures: Coronary artery calcium, inflammatory markers (high-sensitivity C-reactive protein, IL-6, TNFα, adiponectin, leptin), fasting blood tests (glucose, lipids, insulin), and dual-energy x-ray absorptiometry scan for body fat distribution were measured. Results: Coronary artery calcium was detected in eight of 24 PCOS subjects (33%) and two of 24 controls (8%) (odds ratio 5.5, 95% confidence interval 1.03, 29.45, P < 0.03). Traditional CV risk factors did not differ significantly between the two groups, nor did markers of inflammation or adiposity, body fat distribution, or metabolic parameters with the exception of significantly lower quantitative insulin sensitivity check index (marker for insulin resistance) in the PCOS group (P < 0.05). Conclusions: Young, obese women with PCOS have a high prevalence of early asymptomatic coronary atherosclerosis, compared with obese controls. This increased risk is independent of traditional CV risk factors and novel markers of inflammation. These findings underscore the need to screen and aggressively counsel and treat these women to prevent symptomatic CV disease.

scholarly journals High BMI and Insulin Resistance Are Risk Factors for Spontaneous Abortion in Patients With Polycystic Ovary Syndrome Undergoing Assisted Reproductive Treatment: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 11 ◽  
Author(s):  
Yi-Fei Sun ◽  
Jie Zhang ◽  
Yue-Ming Xu ◽  
Zi-Yu Cao ◽  
Yi-Zhuo Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Spontaneous Abortion ◽  
Polycystic Ovary ◽  
Meta Analysis ◽  
Abortion Rate ◽  
Ovary Syndrome ◽  
Assisted Reproductive Treatment ◽  
Increased Risk ◽  
High Bmi

BackgroundThe risk of spontaneous abortion in patients with polycystic ovary syndrome (PCOS) undergoing assisted reproductive treatment (ART) is higher than that in patients without PCOS, however, no definitive risk factors have been confirmed to associate with the high spontaneous abortion rate in PCOS patients undergoing ART. This study was performed to assess the impact of relevant risk factors on spontaneous abortion in patients with PCOS. Clinical questions were formulated and organized according to the PICOS principle.MethodsA systematic review and meta-analysis were conducted on all published studies on PCOS and spontaneous abortion in Embase, PubMed, Web of Science and Cochrane Library. Related risk factors included body mass index (BMI), age, insulin resistance (IR), hyperandrogenism, and chromosome aberrations. All patients were diagnosed as PCOS using the Rotterdam criteria. The primary endpoint was miscarriage and live birth rate. Fixed-effect models were used to analyze homogeneous data, and subgroup and sensitivity analyses were performed on heterogeneous data. The source of heterogeneity was evaluated, and the random effect model was used to summarize the heterogeneity.ResultsAmong 1836 retrieved articles, 22 were eligible and included in the analysis with 11182 patients. High BMI (OR = 1.48, 95% CI [1.32, 1.67], MD = 1.35, 95% CI [0.58,2.12]) and insulin resistance (MD = 0.32, 95% CI [0.15, 0.49]) were associated with an increased risk of spontaneous abortion in PCOS patients undergoing ART. Older age (OR = 0.29, 95% CI [0.29, 0.44], MD = 2.01, 95% CI [0.04, 4.18]), embryonic chromosomal aberrations (OR = 0.75, 95%CI [0.31,1.77]), and hyperandrogenism (MD = 0.10, 95% CI [- 0.02, 0.22]) were not associated with the high spontaneous abortion rate in patients with PCOS. A subgroup analysis of BMI showed that there was no statistically significant difference in the effect between overweight and obesity on spontaneous abortion in PCOS patients undergoing ART (OR = 1.34, 95% [0.97, 1.85]).ConclusionHigh BMI and insulin resistance are two risk factors for an increased risk of spontaneous abortion in PCOS patients undergoing ART, and losing weight and mitigating insulin resistance may decrease the spontaneous abortion rate in these patients undergoing ART.

scholarly journals Hormone therapy after endometrial cancer.

2004 ◽  
Vol 11 (2) ◽  
pp. 305-314 ◽  
Author(s):  
A O Mueck ◽  
H Seeger
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Endometrial Cancer ◽  
Hormone Therapy ◽  
Endometrial Carcinoma ◽  
Low Dose ◽  
Polycystic Ovary ◽  
Ovary Syndrome ◽  
Increased Risk ◽  
Climacteric Complaints

Endometrial carcinoma is listed under the absolute contraindications to hormone therapy (HT). According to current opinion, HT after stage I or II is still considered an option, and continuous combined oestrogen/progestogen replacement therapy (CCEPT) would be recommended. However, up to now, only observational studies have been put forward. Although none of these studies have established an increased rate of recurrence or mortality, alternatives such as phytopreparations and tibolone, or particular psychotherapeutic drugs, such as venlafaxine, should be considered for the relief of climacteric complaints. Progestogen-only therapy (PT) particularly has been considered. However, the currently discussed possible progestogen effects regarding an increased risk of breast cancer have to be taken into account. Indeed, the wider discussion about the gestagen effects regarding the risk of breast cancer is to be considered. Generally, after hysterectomy, at least for patients with cardiovascular risk factors, the preference today is to use low-dose oestrogen therapy (patches or gels) instead of CCEPT, and this is also now recommended for patients after endometrial cancer. This is to be noted because of the risk factors for endometrial carcinoma, such as hypertension, obesity, polycystic ovary syndrome (PCO) and diabetes mellitus. However, each form of HT should be only exceptionally recommended, and the patients must be informed about the risks that exist and the use of alternatives.

scholarly journals Dietary Options in Polycystic Ovary Syndrome (PCOS)

2017 ◽  
Vol 23 (2) ◽  
Author(s):  
Hafsa Kamran ◽  
Maria Aslam ◽  
Shaista Jabeen
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Intervention Program ◽  
Polycystic Ovary ◽  
Glycemic Load ◽  
Energy Restriction ◽  
Moderate Physical Activity ◽  
Obese Women ◽  
Ovary Syndrome ◽  
Female Population ◽  
Increased Risk

Abstract Poly Cystic Ovary Syndrome is the hormonal imbalance that is by and large considered to affect more or less 10% of the female population. PCOs is more common in obese and overweight women, which further increases androgen secretion causing impaired metabolism and reproductive functions. Women with PC-OS are at increased risk of developing cardiovascular diseases, dyslipidemias, hypertension and type II diabetes Mellitus. Weight reduction is difficult to achieve in obese women with PCOS than normal individuals. So a comprehensive lifestyle intervention program including individualized diet with moderate energy restriction based on basic healthy eating principles, at least 30 minutes moderate physical activity 3-5 days a week and behavior modification approach is required. Hypocaloric diets along with modification of carbohydrates have found to be effective. Selection of foods among low glycemic load (GL) and high fiber foods and replacing fats with polyunsaturated fats may be a helpful strategy in PCOS patients. Keywords:  Polycystic Ovary Syndrome (PCOS), Obesity, Insulin Resistance, Diet.

Abstract P191: Does ApoB/A1 Ratio Explain the Increased Risk of Cardiovascular Disease in Indian Asians Compared to Europeans?

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Sian-Tsung Tan ◽  
Abtehale Al-Hussaini ◽  
Sunaina Yadav ◽  
Joban Sehmi ◽  
Mika Ala-Korpela ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Hdl Cholesterol ◽  
Cholesterol Ratio ◽  
Chd Risk ◽  
Increased Risk ◽  
Chd Risk Factors

Introduction Coronary heart disease (CHD) mortality is ∼2-fold higher in Indian Asians (IA) than in European Whites (EW). This is not accounted for by conventional CHD risk factors (type-2 diabetes, cigarette smoking, hypertension, obesity, total or HDL cholesterol). The INTERHEART Study has reported that ApoB/A1 ratio is the single strongest risk factor for CHD accounting for ∼50% of CHD risk; the contribution of ApoB/A1 ratio to the excess CHD risk in IA is not known. Hypothesis We tested the hypothesis that ApoB/A1 ratio is higher in IA than EW and accounts for the ∼2-fold excess CHD risk in IA, independent of conventional CHD risk factors. Methodology We studied 1361 IA and 1028 EW men and women aged 35-75 years, participating in the London Life Sciences Population Study. All participants completed a structured health questionnaire and had blood pressure, height, weight, waist-hip ratio, fasting biochemistry measured. Coronary artery calcium (CAC) was measured by electron beam CT; Agatston score >0 was considered to indicate the presence of coronary atherosclerosis. Results Compared to EW, IA were younger, had higher prevalence of diabetes and hypertension, had higher WHR, and were less likely to smoke. Total and HDL cholesterol were lower, but Total-HDL cholesterol ratio was higher in IA ( table ). ApoB/A1 ratio was higher in IA compared to EW [0.71±0.15 vs. 0.67±0.16, p<0.001], and was independent of conventional CHD risk factors (p<0.001). In univariate analysis, ApoB/A1 ratio was associated with CAC in both populations [Odds ratio (OR) for CAC per 1 SD increase in ApoB/A1 ratio: IA 1.17 (1.05-1.30), p=0.006; EW 1.40 (1.23-1.59), p<0.001]. After adjustment for age, gender, and total-HDL cholesterol ratio, there was no association between ApoB/A1 ratio and CAC [OR: IA 0.95 (0.74-1.21), p=0.66; EW 0.98 (0.72-1.33), p=0.88]. Conclusions ApoB/A1 is higher in IA compared to EW, but not independently associated with coronary calcification in either population. ApoB/A1 ratio does not explain the ∼2-fold increased risk of CHD in IA. Europeans Indian Asians P-value N 1028 1361 Age (years) 55.5 54.2 0.002 Male gender (%) 70.3 62.0 <0.0001 Ever Smoked (%) 54.8 15.1 <0.0001 ApoB/A1 ratio 0.67 (0.16) 0.71 (0.15) <0.0001 Total: HDL Cholesterol Ratio 4.12 (1.10) 4.23 (1.03) <0.0001 HDL cholesterol (mmol/L) 1.37 (0.39) 1.24 (0.32) <0.0001 Type-2 Diabetes (%) 8.2 20.1 <0.0001 Treated Hypertension (%) 19.2 31.3 <0.0001 Waist-Hip Ratio 0.92 (0.08) 0.94 (0.08) <0.0001 Coronary artery calcium score greater than 0 (%) 54.1 51.1 0.15 Table: Characteristics of study participants

Abstract P165: Associations of Coronary Artery Calcium Volume and Density With Incident Heart Failure in the Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Nketi I Forbang ◽  
Erin Michos ◽  
Sonia Ponce ◽  
Isac Thomas ◽  
Matthew Allison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Low Frequency ◽  
P Value ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Increased Risk ◽  
Incident Heart Failure

Background: Coronary artery calcium (CAC) predicts incident heart failure (HF) independent of cardiovascular disease (CVD) risk factors. In MESA, Components of CAC, volume and density, have opposite associations with incident CVD, such that for a given volume of CAC, higher CAC density is inversely associated with events. The relationship between CAC volume and density with HF is unknown. Methods: We studied 6814 participants in a multi-ethnic, community-based cohort, free from clinical CVD at recruitment. CAC volume and density were measured by non-contrast cardiac CT at the baseline exam (2000-2002). Adjudicated HF events were assessed through 2014, and analysis limited to those with imaging confirmation and estimated ejection fraction (EF). Cox proportional hazard was used to estimate independent associations of baseline CAC volume and density with incident HF: HF with reduced (< 50%), and preserved EF (HFrEF & HFpEF respectively). Results: The mean age was 62 + 10 years, 47% were men, 38% identified as European-, 28% as African-, 22% as Hispanic-, and 12% as Chinese-ethnicity. Average time to 189 HF events (119 HFrEF & 70 HFpEF) was 6.6 years. In unadjusted models, higher CAC volume (HR 1.27 [1.02-1.59], p=0.03), but not CAC density (HR 0.87 [0.67-1.13], p=0.29) was significantly associated with incident HF, non-significant associations were observed with HFrEF, or HFpEF, and no significant associations were observed for all three outcomes after adjustments for demographics and CVD risk factors (Table). Also, in unadjusted analyses, stratified by sex (p-value for interaction = 0.13), higher CAC volume was associated with increased risk for HF (HR 1.37 [1.03-1.81], p=0.03) and HFpEF (HR 1.76 [0.99-3.16], p=0.06), in males only. No significant associations were observed after adjustments. Conclusion: In a multi-ethnic cohort, CAC volume and density were not independently associated with HF, the trend for volume was positive while density was inverse. Low frequency of incident HF in our cohort was an important limitation.

scholarly journals Evidence for an Association between Metabolic Cardiovascular Syndrome and Coronary and Aortic Calcification among Women with Polycystic Ovary Syndrome

2004 ◽  
Vol 89 (11) ◽  
pp. 5454-5461 ◽  
Author(s):  
E. O. Talbott ◽  
J. V. Zborowski ◽  
J. R. Rager ◽  
M. Y. Boudreaux ◽  
D. A. Edmundowicz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Cardiovascular Risk ◽  
Polycystic Ovary Syndrome ◽  
Body Mass ◽  
Polycystic Ovary ◽  
Electron Beam Tomography ◽  
Ovary Syndrome ◽  
Increased Risk ◽  
Metabolic Cardiovascular Syndrome

Abstract Women with polycystic ovary syndrome (PCOS) exhibit an adverse cardiovascular risk profile, characteristic of the metabolic cardiovascular syndrome (MCS). The aim of this study was to determine the prevalence of coronary artery (CAC) and aortic (AC) calcification among middle-aged PCOS cases and controls and to explore the relationship among calcification, MCS, and other cardiovascular risk factors assessed 9 yr earlier. This was a prospective study of 61 PCOS cases and 85 similarly aged controls screened in 1993–1994 for risk factors and reevaluated in 2001–2002. The main outcome measures were CAC and AC, measured by electron beam tomography. Women with PCOS had a higher prevalence of CAC (45.9% vs. 30.6%) and AC (68.9% vs. 55.3%) than controls. After adjustment for age and body mass index, PCOS was a significant predictor of CAC (odds ratio = 2.31; P = 0.049). PCOS subjects were also 4.4 times more likely to meet the criteria for MCS than controls. High-density lipoprotein cholesterol and insulin appeared to mediate the PCOS influence on CAC. Interestingly, total testosterone was an independent risk factor for AC in all subjects after controlling for PCOS, age, and body mass index (P = 0.034). We conclude that women with PCOS are at increased risk of MCS and demonstrate increased CAC and AC compared with controls. Components of MCS mediate the association between PCOS and CAC, independently of obesity.

scholarly journals Obesity, Polycystic Ovary Syndrome, and Infertility: A New Avenue for GLP-1 Receptor Agonists

2020 ◽  
Vol 105 (8) ◽  
pp. e2695-e2709 ◽  
Author(s):  
Hellas Cena ◽  
Luca Chiovato ◽  
Rossella E Nappi
Keyword(s):  
Weight Loss ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Therapeutic Option ◽  
Evidence Synthesis ◽  
Treatment Options ◽  
Obese Women ◽  
Ovary Syndrome ◽  
Receptor Agonists ◽  
Increased Risk

Abstract Context Obesity is responsible for an increased risk of sub-fecundity and infertility. Obese women show poorer reproductive outcomes regardless of the mode of conception, and higher body mass index (BMI) is associated with poorer fertility prognosis. Polycystic ovary syndrome (PCOS) is one of the leading causes of infertility, and many women with PCOS are also overweight or obese. Evidence Acquisition The aim of the present narrative review is to describe the mechanisms responsible for the development of infertility and PCOS in women with obesity/overweight, with a focus on the emerging role of glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) as a therapeutic option for obese women with PCOS. Evidence synthesis Weight reduction represents the most significant factor affecting fertility and pregnancy outcomes. Current experimental and clinical evidence suggests the presence of an underlying pathophysiological link between obesity, GLP-1 kinetic alterations, and PCOS pathogenesis. Based on the positive results in patients affected by obesity, with or without diabetes, the administration of GLP-1 RA (mainly liraglutide) alone or in combination with metformin has been investigated in women with obesity and PCOS. Several studies demonstrated significant weight loss and testosterone reduction, with mixed results relative to improvements in insulin resistance parameters and menstrual patterns. Conclusions The weight loss effects of GLP-1 RA offer a unique opportunity to expand the treatment options available to PCOS patients.

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