Torchen, L. C. (2017). Cardiometabolic Risk in PCOS: More than a Reproductive Disorder. Current diabetes reports, 17(12), 137. https://doi.org/10.1007/s11892-017-0956-2
Torchen LC. Cardiometabolic Risk in PCOS: More than a Reproductive Disorder. Current diabetes reports. 2017;17(12):137. doi:10.1007/s11892-017-0956-2
Torchen, L. C. "Cardiometabolic Risk in PCOS: More than a Reproductive Disorder." Current diabetes reports, vol. 17, no. 12, 2017, pp. 137.
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RRM Academy Synopsis
PCOS raises type 2 diabetes risk; heart disease risk is unquantified
This 2017 review finds PCOS raises type 2 diabetes risk among affected women, and its heart disease risk remains unquantified. The diabetes risk is well established in the classic phenotype, which carries the greatest metabolic risk. PCOS is now also called polyendocrine metabolic ovarian syndrome (PMOS).
Key Findings
Women with PCOS, lean or obese, had 35–40% lower insulin-mediated glucose disposal than control women of similar age and body composition.
Impaired glucose tolerance affected about 30% of adult women with PCOS and about 30% of affected adolescents, by the estimates the review cites.
Nurses' Health Study data suggested PCOS was associated with a two times higher risk of type 2 diabetes. Irregular menses stood in for the diagnosis.
No prospective, longitudinal studies have investigated cardiovascular events in women with PCOS. Many studies using surrogate endpoints found evidence of increased cardiovascular disease risk.
One study of girls whose mothers have PCOS found a decreased disposition index, a measure of insulin secretion, around puberty. It was still present after 3 years.
Interpretation
The paper is a review that summarizes existing studies. Studies of cardiovascular events had limits: retrospective or cross-sectional design, small samples, or too few women followed past menopause. The diagnostic criteria for PCOS all rest on expert opinion. Insulin resistance is common in PCOS but varies between women. Studies using the broader Rotterdam phenotypes may understate the metabolic risk of the NIH phenotype.
RRM Context
Restorative reproductive medicine looks for the underlying cause behind a diagnosis. PMOS, the newer name for PCOS, carries metabolic function in its title. The review sets insulin and glucose findings beside ovulation and androgens as parts of one condition.
Our editorial summary of this paper, not the article's abstract.
Abstract
Purpose of Review
Polycystic ovary syndrome (PCOS) is diagnosed by its characteristic reproductive features. However, PCOS is also associated with metabolic abnormalities, including insulin resistance and β-cell dysfunction. The severity of these abnormalities varies according to the reproductive phenotype, with the so-called NIH or classic phenotype conferring the greatest metabolic risk. The increased risk for type 2 diabetes (T2D) is well established among affected women with the NIH phenotype, but whether PCOS also confers an increased risk for cardiovascular events remains unknown.
Recent Findings
Recent studies in daughters of affected women have found evidence for pancreatic β-cell dysfunction prior to menarche. Further, genetic analyses have provided evidence that metabolic abnormalities such as obesity and insulin resistance contribute to the pathogenesis of PCOS. PCOS increases the risk for T2D. However, the risk for cardiovascular disease has not been quantified, and prospective, longitudinal studies are still critically needed.
Recent diagnostic and pharmacologic developments have focused renewed attention on polycystic ovary syndrome. Clinical features of the syndrome include anovulation, hyperandrogenism and menstrual dysfunction, but several other abnormalities, including hyperinsulinemia, luteinizing hormone hypersecretion, elevated testosterone levels and acyclic estrogen production, have been documented. Accompanying obesity and lipid abnormalities compound the risk of developing diabetes mellitus or cardiovascular disease, and chronic anovulation increases the risk for endometrial cancer. A careful history and physical examination should guide diagnostic testing. Slowly progressive hyperandrogenic symptoms with anovulation of peripubertal onset often represent polycystic ovary syndrome. Treatment goals include symptom management and the identification and prevention of potential cardiovascular risks. Treatment should take into account the patient's desire for fertility. Advances in transvaginal ultrasonography and infertility treatments, including newer medications, have facilitated assisted reproduction in patients with polycystic ovary syndrome. Ongoing pharmacologic research focusing on the treatment of insulin resistance appears promising in reversing the longterm complications of the syndrome.
Livadas S et al., 2022·World journal of diabetes·Free full text on PubMed Central
Polycystic ovary syndrome (PCOS) often coexists with a wide spectrum of dysglycemic conditions, ranging from impaired glucose tolerance to type 2 diabetes mellitus (T2D), which occur to a greater extent compared to healthy body mass index-matched women. This concurrence of disorders is mainly attributed to common pathogenetic pathways linking the two entities, such as insulin resistance. However, due to methodological flaws in the available studies and the multifaceted nature of the syndrome, there has been substantial controversy as to the exact association between T2D and PCOS which has not yet been elucidated. The aim of this review is to present the best available evidence regarding the epidemiology of dysglycemia in PCOS, the unique pathophysiological mechanisms underlying the progression of dysglycemia, the most appropriate methods for assessing glycemic status and the risk factors for T2D development in this population, as well as T2D risk after transition to menopause. Proposals for application of a holistic approach to enable optimal management of T2D risk in PCOS are also provided. Specifically, adoption of a healthy lifestyle with adherence to improved dietary patterns, such the Mediterranean diet, avoidance of consumption of endocrine-disrupting foods and beverages, regular exercise, and the effect of certain medications, such as metformin and glucagon-like peptide 1 receptor agonists, are discussed. Furthermore, the maintenance of a healthy weight is highlighted as a key factor in achievement of a significant reduction of T2D risk in women with PCOS.
Polycystic ovary syndrome is a common problem affecting approximately 5% of women of reproductive age when defined by clinical features of anovulation and hyperandrogenism. Metabolic derangements associated with this condition may predispose to a range of diseases with attendant morbidity and mortality risks. In general, available data support significantly increased rates of type II diabetes mellitus, dyslipidemia, and endometrial cancer in PCOS that are not completely explained by obesity; data also suggest that rates of hypertension, gestational diabetes, and pregnancy-induced hypertension may likewise be increased, although the extent to which obesity mediates these risks is not clear. The increased prevalence of several cardiovascular risk factors in PCOS and limited cross-sectional data suggest that cardiovascular disease should be more likely in PCOS, but prospective data are lacking to confirm this supposition. Limited data have suggested an association between PCOS and ovarian cancer risk and require further study. The present data do not support an increased risk for breast cancer in this condition. Long-term prospective data are clearly needed to better delineate the nature and magnitude of disease risks associated with PCOS, with appropriate adjustment for associated obesity. Such information is a necessary background for understanding the role of established and emerging PCOS therapies, including oral contraceptives, intermittent progesterone, ovulation induction agents, and insulin sensitizers, in modifying such risks. In the meantime, close follow-up of women with PCOS and encouragement of lifestyle practices likely to reduce disease risks, such as regular exercise and weight control, should be standard practice.
Chandrasekaran S et al., 2018·The Obstetrician & Gynaecologist
Key content The risk factors for metabolic syndrome include central obesity, hypertension, atherogenic dyslipidaemia and insulin resistance. Metabolic syndrome affects 33% of women with polycystic ovary syndrome (PCOS) and has been less well researched than other features such as infertility, anovulation and hirsutism. Consequences of metabolic syndrome include cardiovascular disease, type II diabetes, cancer, sleep apnoea and psychological problems. Cardiometabolic risk screening involves obtaining data on smoking history, weight, body mass index, waist circumference, blood pressure, lipid profile, and taking an oral glucose tolerance test. Management of metabolic syndrome should focus on risk factors and individual components. Lifestyle modification is the only recommended intervention at present. Learning objectives To know the pathogenesis and consequences of metabolic syndrome in women with PCOS. To understand the diagnostic criteria and screening procedures for metabolic syndrome. To learn how to manage metabolic syndrome in women with PCOS. Ethical issues Potential preventive long‐term medication raises two issues: duration of therapy and unwarranted adverse effects. Advocating bariatric surgery without availability of robust evidence in PCOS women.
PMOS / PCOS › Long Term Health › Metabolic Risk
PMID 29128916 29128916 DOI 10.1007/s11892-017-0956-2 10.1007/s11892-017-0956-2 Torchen et al. 2017, Torchen 2017
Cite this article
Torchen, L. C. (2017). Cardiometabolic Risk in PCOS: More than a Reproductive Disorder. Current diabetes reports, 17(12), 137. https://doi.org/10.1007/s11892-017-0956-2
Torchen LC. Cardiometabolic Risk in PCOS: More than a Reproductive Disorder. Current diabetes reports. 2017;17(12):137. doi:10.1007/s11892-017-0956-2
Torchen, L. C. "Cardiometabolic Risk in PCOS: More than a Reproductive Disorder." Current diabetes reports, vol. 17, no. 12, 2017, pp. 137.