Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder in women between menarche and menopause. Clinical hyperandrogenism is the most important diagnostic criterion of the syndrome, which manifests as hirsutism in 70% of cases. Hirsute carriers of PCOS have high cardiovascular risk. Lipid accumulation product (LAP) is an index for the evaluation of lipid accumulation in adults and the prediction of cardiovascular risk. The aim of this study was to evaluate the association between LAP and hirsutism in women with PCOS. This was a cross-sectional observational study of a secondary database, which included 263 patients who had visited the Hyperandrogenism Outpatient Clinic from November 2009 to July 2014. The exclusion criteria were patients without Ferriman-Gallwey index (FGI) and/or LAP data. We used the Rotterdam criteria for the diagnosis of PCOS. All patients underwent medical assessment followed by measurement and recording of anthropometric data and the laboratory tests for measurement of the following: thyroid-stimulating hormone, follicle-stimulating hormone, prolactin, total testosterone, sex hormone binding globulin, 17-α-hydroxyprogesterone (follicular phase), glycohemoglobin A1c, and basal insulin. In addition, the subjects underwent lipid profiling and oral glucose tolerance tests. Other laboratory measurements were determined according to clinical criteria. LAP and the homeostatic model assessment index (HOMA-IR) were calculated using the data obtained. We divided patients into two groups: the PCOS group with normal LAP (< 34.5) and the PCOS group with altered LAP (> 34.5) to compare the occurrence of hirsutism. For statistical analysis, we used SPSS Statistics for Windows® and Microsoft Excel programs, with descriptive (frequencies, percentages, means, and standard deviations) and comparative analyses (Student's t-test and Chi-square test). We considered relations significant when the p-value was ≤ 0.05. LAP was high in most patients (n = 177; 67.3%) and the FGI indicated that 58.5% of the patients (n = 154) had hirsutism. The analysis by LAP quartiles showed a positive correlation (p = 0.04) among patients with a high FGI and an upper quartile LAP (> 79.5) when compared with those with LAP < 29.0 (lower quartile). This study demonstrated an association between high LAP and hirsutism. The FGI could represent a simple and low-cost tool to infer an increased cardiovascular risk in women with PCOS.
Highlights
Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder in women between menarche and menopause
The inclusion criteria were as follows: patients with PCOS (Rotterdam criteria) less than 40 years old; those who had completed at least 2 years after menarche at the time of evaluation; body mass index (BMI) ! 18.5 kg/m2 and < 40 kg/m2; patients who were not using medications that interfere with hormone and/or metabolic measurements for at least 3 months; and patients in whom metformin use had been suspended for 2 months
The lower (Q1 1⁄4 29.0) and upper (Q3 1⁄4 79.5) quartiles showed significant differences in Lipid accumulation product (LAP) (p 1⁄4 0.04). This statistical relation was confirmed using odds ratios that demonstrated that women with LAP > 79.5 had a 2-fold higher association with the altered Ferriman-Gallwey index (FGI)
Summary
Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder in women between menarche and menopause It may reach a prevalence > 18% according to the Rotterdam classification criterion.[1,2,3] This condition can manifest in four different phenotypes: classical phenotype (anovulation or oligo-ovulation with irregular menses, clinical and/or laboratory hyperandrogenism, and polycystic ovaries on ultrasound, US); ovulatory phenotype (hyperandrogenism and polycystic ovaries on US); nonhyperandrogenic phenotype (anovulation or oligo-ovulation and polycystic ovary on US); and the phenotype that includes hyperandrogenism and anovulation or oligo-ovulation, but with no changes on US.[2,4]. The FGI is considered a good instrument for evaluating hirsutism, even considering ethnic differences among patients.[5,6,7] In adult women, hirsutism, acne, and alopecia are good substitutes of biochemical hyperandrogenism and should be considered as indicators of excessive androgen production. We considered only hirsutism as an indicator of hyperandrogenism
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