Diastolic dysfunction and increased serum homocysteine concentrations may contribute to increased cardiovascular risk in patients with polycystic ovary syndrome
Yarali H,Yildirir A,Aybar F,Kabakçi G,Bükülmez O,Akgül E,Oto A
Published September 5, 2001Fertility and Sterility, 76(3), 511-516
Yarali, H., Yildirir, A., Aybar, F., Kabakçi, G., Bükülmez, O., Akgül, E., & Oto, A. (2001). Diastolic dysfunction and increased serum homocysteine concentrations may contribute to increased cardiovascular risk in patients with polycystic ovary syndrome. Fertility and Sterility, 76(3), 511-516. https://doi.org/10.1016/s0015-0282(01)01937-9
Yarali H, Yildirir A, Aybar F, Kabakçi G, Bükülmez O, Akgül E, Oto A. Diastolic dysfunction and increased serum homocysteine concentrations may contribute to increased cardiovascular risk in patients with polycystic ovary syndrome. Fertil Steril. 2001;76(3):511-516. doi:10.1016/s0015-0282(01)01937-9
Yarali, Hakan, et al. "Diastolic dysfunction and increased serum homocysteine concentrations may contribute to increased cardiovascular risk in patients with polycystic ovary syndrome." Fertility and Sterility, vol. 76, no. 3, 2001, pp. 511-516.
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Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey. yarali@ada.net.tr01wntqw50
PCOS is linked to weaker heart relaxation and higher homocysteine
In a 2001 case-control study of 30 women with PCOS and 30 regularly cycling women, the PCOS group had weaker diastolic heart function and higher homocysteine. Seven out of 30 women with PCOS had a low early-to-late filling ratio, against 1 out of 30 comparison women.
Key Findings
Seven of 30 women with PCOS (23%) had an E/A ratio below 1, the authors' marker of diastolic dysfunction. One comparison woman did.
Women with PCOS had a significantly lower early mitral flow velocity (P = .04), a lower E/A ratio (P = .01) and a longer isovolumic relaxation time (P = .003).
All systolic function measures were comparable between the two groups.
Mean serum homocysteine was significantly higher in the PCOS group (P = .01), as was uric acid (P = .04). Vitamin B12, folate, fibrinogen and plasminogen activator inhibitor activity were comparable.
Fasting insulin correlated negatively with the E/A ratio (r = -0.387, P < .05). The cholesterol/HDL ratio correlated negatively with the early mitral peak (r = -0.474, P < .05).
Interpretation
The authors ran a prospective case-control study at one university hospital, with 30 women in each group. PCOS (also called PMOS, Polyendocrine Metabolic Ovarian Syndrome) was diagnosed from irregular cycles, high testosterone and confirmed absence of ovulation. Comparison women were medical students or nurses. The PCOS group was younger, on average 27.9 versus 31.4 years. The authors note that heart relaxation may worsen with age, so the age gap may have understated the difference. They conclude that diastolic dysfunction may be an early marker of higher heart disease risk in PCOS.
RRM Context
Restorative reproductive medicine treats PCOS as a whole-body condition. The paper measures insulin, blood fats and homocysteine alongside the heart findings in women with anovulatory PCOS. That fits a root-cause approach that evaluates metabolic and heart health along with the cycle.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To assess cardiac flow parameters in patients with polycystic ovary syndrome (PCOS).
Design
A prospective case-control study.
Setting
University-based hospital.
Patients
Thirty consecutive patients with PCOS were enrolled. Thirty women with regular menstrual cycles served as the controls.
Interventions
Systolic and diastolic function parameters were assessed by standard two-dimensional and M-mode echocardiography. Insulin sensitivity was evaluated by a standard 75-g oral glucose tolerance test and area-under-curve insulin analysis. Serum hormones, lipid profile, homocysteine, vitamin B(12), folate, fibrinogen, uric acid, and plasminogen activator inhibitor-I concentrations were measured.
Main Outcome Measures
Systolic and diastolic function parameters, insulin sensitivity and serum homocysteine levels.
Results
The mean serum homocysteine and uric acid concentrations were significantly higher in the PCOS group. Patients with PCOS had significant hyperinsulinemia. All systolic function parameters were comparable between the two groups. However, patients with PCOS had significantly lower peak mitral flow velocity in early diastole and significantly lower ratio between the early and late peak mitral flow velocities and also had significantly longer isovolumic relaxation time, reflecting a trend for nonrestrictive-type diastolic dysfunction. The area-under-curve insulin correlated positively with peak mitral flow velocity in late diastole (r = 0.375). The mean cholesterol/high-density lipoprotein ratio correlated negatively with mean mitral flow velocity in early diastole (E) peak (r = -0.474). The mean fasting insulin level correlated negatively with mean E/A ratio (r = -0.387).
Conclusions
Diastolic dysfunction and increased serum homocysteine concentrations may contribute to increased cardiovascular disease risk in patients with PCOS.
PMOS / PCOS has four diagnostic phenotypes and distinct metabolic, reproductive, and mental health implications. How RRM-trained clinicians approach diagnosis and treatment differently.
