Association of Hyperandrogenemic and Metabolic Phenotype with Carotid Intima-Media Thickness in Young Women with Polycystic Ovary Syndrome

Abstract

Women with polycystic ovary syndrome (PCOS) tend to have multiple risk factors for cardiovascular disease. They include abdominal obesity, dyslipidemia, and diabetes. Studies to date have failed to demonstrate premature atherosclerosis of the carotid artery in young women with PCOS. Measuring the carotid intima-media thickness (IMT) is a relatively simple and reliable index of subclinical atherosclerosis and is able to predict later myocardial infarction and stroke. The investigators carried out a prospective study of 130 white women 17 to 35 years of age, 75 of whom had PCOS, defined as chronic anovulation with fewer than 8 menses a year and an elevated free androgen index. Carotid IMT, the distance between the lumen-intima and media interfaces, was measured by B-mode ultrasonography. The PCOS and control groups were similar in age and body mass index, but women with PCOS had more marked central adiposity. All measured androgen levels were higher in women with PCOS, whereas levels of sex hormone-binding globulin were significantly lower in these subjects. Women with PCOS had significantly lower levels of high-density lipoprotein cholesterol than control women but significantly higher levels of low-density lipoprotein (LDL) cholesterol. Women with PCOS had significantly higher indices of insulin resistance and fasting glucose-to-insulin ratios. They also tended to have higher blood glucose levels. Both mean and maximum carotid IMT values were significantly higher in the PCOS group. IMT correlated to a significant degree with numerous hormonal and cardiovascular risk factors, including the presence of PCOS, body mass index, and levels of LDL cholesterol and triglycerides. A parental history of diabetes or coronary heart disease significantly predicted IMT. On multivariate analysis, not only PCOS status, but also age and body mass index were independent positive predictors of IMT. Levels of dehydroepiandrosterone sulfate (DHEAS) correlated negatively with IMT. Four factors-PCOS status, age, body mass index, and DHEAS-explained approximately two thirds of the variability in IMT. Women with PCOS have increased cardiovascular risk factors and indices of preclinical atherosclerosis at a relatively early age. Androgens-particularly DHEAS-may partly counter the adverse effects of dyslipidemia and insulin resistance in these women, but whether clinical cardiovascular disease is lessened or eliminated remains to be determined.