MON-213 Evaluation of Type 2 Diabetes and Cardiovascular Disease Risk Factors in Reproductive-Age Women with Polycystic Ovary Syndrome (PCOS) Using the 2014 Androgen Excess and PCOS Society Criteria for the Polycystic Ovarian Morphology

Abstract

Polycystic ovary syndrome (PCOS) is a complex and prevalent endocrine condition among reproductive-age women associated with adverse metabolic consequences. Metabolic syndrome (MetS) is a cluster of risk factors conferring an increased risk for type 2 diabetes (DM2) and cardiovascular disease (CVD). Research has been limited, in part, due to marked heterogeneity in criteria employed to determine MetS, retrospective data collection, and the use of older or less accurate criteria to diagnose PCOS and polycystic ovarian morphology (PCOM). We aimed to 1) examine the prevalence of MetS and evaluate DM2 and CVD risk factors in reproductive-age Canadian women with PCOS; and, 2) assess the relevance of MetS to clinical and biochemical features of PCOS using a prospective comprehensive approach and a rigorously-defined PCOS population. Baseline observations were evaluated in 237 women with PCOS (Androgen Excess and PCOS [AE-PCOS] Society 2006 criteria for PCOS and AE-PCOS Society 2014 recommendations to determine PCOM) and 42 healthy controls (18-36 years). Clinical and biochemical measures of MetS (International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute 2009), DM2 (Diabetes Canada Clinical Practice Guidelines 2018), and CVD risk factors (AE-PCOS Society statement 2010) were assessed. The prevalence of MetS was 29.5% in women with PCOS; that is, approximately 6-fold higher than age-matched controls (P<0.001). Women with PCOS presented with higher glucose abnormality, acanthosis nigricans, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, and lower sex-hormone binding globulin (SHBG) concentrations when compared with controls after accounting for differences in the body mass index (BMI; P<0.01). Women with both PCOS and MetS exhibited exacerbated insulin and glucose responses to a 75-gram glucose tolerance test, increased TC/HDL-C ratio, TC, and SHBG concentrations, as well as increased hirsutism and acanthosis nigricans when compared to women with PCOS without MetS after adjusting for BMI (P≤0.05). Canadian reproductive-age women with PCOS whose PCOM were characterized according to the AE-PCOS Society 2014 recommendations have a high prevalence of MetS and exhibit adverse cardiometabolic and DM2 risk profiles. MetS is associated with increased hyperandrogenism and hypercholesterolemia in women with PCOS attributed to inherent insulin resistance, hyperinsulinemia, and synergistic effects of concomitant obesity. Screening and regular monitoring for CVD and DM2 risk factors are reinforced for women with PCOS across the reproductive lifespan.