Does family history of cardiovascular disease predict the metabolic profile of PCOS patients?

Abstract

OBJECTIVE: Women with PCOS are at risk for insulin resistance and the development of type 2 diabetes. In addition, they often have other risk factors for cardiovascular disease, including dyslipidemia, hypertension, obesity and central adiposity. Epidemiologic studies of cardiovascular events in women with PCOS have been inconclusive, despite the suggestion of a higher risk for cardiovascular disease. The aim of the present study was to determine whether a family history of cardiovascular or other metabolic dysfunction predicts the metabolic profile of patients with PCOS. DESIGN: A cross-sectional study of 56 patients presenting to a multidisciplinary PCOS clinic, with confirmed diagnosis of PCOS by Rotterdam criteria. MATERIALS AND METHODS: A three generation pedigree taken by a genetic counselor was analyzed for first degree relatives with a history of type 2 diabetes, myocardial infarction (MI) or cardiovascular disease (CVD), hypertension, dyslipidemia or overweight. Assessment of the metabolic profile included body mass index (BMI), waist-hip ratio (WHR), blood pressure, glucose tolerance (2 hour GTT) and lipid profile (LDL, HDL and triglycerides). Students t-test and chi square analysis were used as appropriate to determine whether family history predicts evidence of metabolic dysfunction in patients. RESULTS: BMI ranged from 18.9-47, with a mean of 30.9 (SD=7.4); 24% of patients would be characterized as overweight and 43% as obese. Mean WHR was 0.80. Clinical hypertension was identified in 19% of our patients; 12% had impaired glucose tolerance; 20% had elevated LDL; 21% had elevated triglycerides and 13% percent had reduced HDL. Mean BMI was higher among patients with a positive family history of hypertension (33.3) than those without a family history of hypertension (27.9) (p<.01). Mean BMI was higher among patients with a positive family history of MI or CVD (35.4) than those without a family history of MI or CVD (29.6) (p<.05). An elevated LDL (above 130 mg/dl) was more frequent among patients with a positive family history of MI or CVD (50%) than those without a family history (12.8%) (p<.01). A positive family history of type 2 diabetes, dyslipidemia or overweight in first degree relatives was not associated with increased metabolic dysfunction. CONCLUSIONS: Our findings suggest that a history of cardiovascular disease in a first degree relative may be an important predictor of the risks of metabolic dysfunction in patients with PCOS.