This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sattar, N. Search for Related Content Social Bookmarking                         What's this?

Review: PCOS, insulin resistance and long-term risks for diabetes and vascular disease

Naveed Sattar BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK, nsattar{at}clinmed.gla.ac.uk

Insulin resistance is an important `upstream' driver for the reproductive and metabolic abnormalities in many women with polycystic ovarian syndrome (PCOS), in particular those who are overweight or obese. They frequently exhibit visceral adiposity, glucose intolerance, a dyslipidaemia which mirrors the pattern in type 2 diabetes, low-grade inflammation, and endothelial dysfunction. They are at elevated risk for type 2 diabetes (about two to four-fold relative to weight matched controls) and cardiovascular events (current best estimates at 50% higher compared with age, body mass index matched women without PCOS). Due to higher diabetes risk, women with PCOS who have other risk factors (e.g. obesity, family history of diabetes) would benefit from screening for diabetes, although the most efficient methods to do so require further investigation. Furthermore, despite the higher relative risk for coronary heart disease (CHD), absolute CHD risk is generally low in young women and thus routine lipid measurements or blood pressure in all women with PCOS would be redundant as such measurements will probably not alter clinical management. Rather, traditional risk measures should be restricted to those with significant other risk factors e.g. family history of premature vascular disease, diabetes. Finally, although recent trial evidence does not support a significant benefit of metformin in fertility treatments for PCOS, metformin does improve metabolic profile in the short term. However, longer-term formal trials of metformin are required to better understand its metabolic and vascular benefit in PCOS. Br J Diabetes Vasc Dis 2009;9:15—18

Key Words: PCOS • insulin resistance • diabetes • CHD • metformin

References

• The Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19:41-7.[Abstract/Free Full Text]
• Chang JR, Nakamura RM, Howard LJ, Kaplan SA Insulin resistance in nonobese patients with polycystic ovarian disease. J Clin Endocrinol Metab 1983;57:356-9.[Abstract/Free Full Text]
• Nestler JE, Jakubowicz DJ Lean women with polycystic ovary syndrome respond to insulin reduction with decreases in ovarian P450c17 activity and serum androgens. J Clin Endocrinol Metab 1997;82:4075-9.[Abstract/Free Full Text]
• Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997;18:774-800.[Abstract/Free Full Text]
• Pirwany IR, Fleming R., Greer IA, Packard CJ, Sattar N. Lipids and lipoprotein subfractions in women with PCOS: relationship to metabolic and endocrine parameters. Clin Endocrinol (Oxf) 2001;54:447-53.[CrossRef][Medline] [Order article via Infotrieve]
• Kelly CJ, Lyall H., Petrie JR et al. A specific elevation in tissue plasminogen activator antigen in women with polycystic ovarian syndrome. J Clin Endocrinol Metab 2002;87:3287-90.[Abstract/Free Full Text]
• Kelly CC, Lyall H., Petrie JR, Gould GW, Connell JM, Sattar N. Low grade chronic inflammation in women with polycystic ovarian syndrome. J Clin Endocrinol Metab 2001;86:2453-5.[Abstract/Free Full Text]
• Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84:165-9.[Abstract/Free Full Text]
• Solomon CG, Hu FB, Dunaif A. et al. Menstrual Cycle Irregularity and Risk for Future Cardiovascular Disease. J Clin Endocrinol Metab 2002;87:2013-7.[Abstract/Free Full Text]
• Wallace AM, Sattar N. The changing role of the clinical laboratory in the investigation of polycystic ovarian syndrome. Clin Biochem Rev 2007;28:79-92.[Medline] [Order article via Infotrieve]
• Vrbikova J., Cibula D., Dvorakova K. et al. Insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004;89:2942-5.[Abstract/Free Full Text]
• Solomon CG, Hu FB, Dunaif A. et al. Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. JAMA 2001;286:2421-6.[Abstract/Free Full Text]
• British Cardiac Society; British Hypertension Society; Diabetes UK; HEART UK; Primary Care Cardiovascular Society; Stroke Association. JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005;91(suppl 5):v1-52.[Free Full Text]
• Moll E., Bossuyt PM, Korevaar JC, Lambalk CB, van der Veen F. Effect of clomifene citrate plus metformin and clomifene citrate plus placebo on induction of ovulation in women with newly diagnosed polycystic ovary syndrome: randomised double blind clinical trial. BMJ 2006;332:1485.[Abstract/Free Full Text]
• Legro RS, Barnhart HX, Schlaff WD et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med 2007;356:551-66.[Abstract/Free Full Text]
• Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:854-65.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Knowler WC, Barrett-Connor E., Fowler SE et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403.[Abstract/Free Full Text]
• Holman RR, Paul SK, Bethel MA et al. 10-Year follow-up of intensive glucose control in type 2 Diabetes. UKPDS 80. New Engl J Med 2008;359:1577-89.[Abstract/Free Full Text]

The British Journal of Diabetes & Vascular Disease, Vol. 9, No. 1, 15-18 (2009)
DOI: 10.1177/1474651408101369


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				T. A Mahmood Obesity: a reproductive hurdle The British Journal of Diabetes & Vascular Disease, January 1, 2009; 9(1): 3 - 4. [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sattar, N. Search for Related Content Social Bookmarking                         What's this?