7. Metabolic disorders and PCO

PCOs is considered by multiple metabolic disorders which may associate to increase risk of hypertension and cardiovascular disease. One study used menstrual irregularity as a predictive factor for assessment of cardiovascular events in a 15-year period, in PCOs women. There was an insignificant increase in overall stroke risk and in ischemic stroke risk associated with "very irregular" menstrual cycles [57]. In PCO women, higher prevalence of hypertension is related to insulin. Hyperinsulinemia have been connected with an increase in intracellular sodium and calcium, along with vascular smooth muscle hypertrophy due to insulin-like growth factor-1 (IGF-1) activity [58]. Simultaneously, androgen excess stimulates sympathetic nerve activity, as another etiology of hypertension in this population [59].

Author details

Elham Pourmatroud

References

Sarem Women Hospital, Tehran, Iran

10.1016/S0002-9378(15)30642-6

DOI: 10.1016/j.fertnstert.2008.06.035

Address all correspondence to: e.pourmatroud@yahoo.com

182-185. DOI: 10.1046/j.1469-0705.1995.06030182.x

[1] Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. The Journal of Clinical Endocrinology and Metabolism. 2004;89(6):2745-2749. DOI: 10.1210/jc.2003-032046

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[2] Botsis D, Kassanos D, Pyrgiotis E, Zourlas PA. Sonographic incidence of polycystic ovaries in a gynecological population. Ultrasound in Obstetrics & Gynecology. 1995;6(3):

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[4] Roe AH, Dokras A. The diagnosis of polycystic ovary syndrome in adolescents. Reviews

[5] The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group 2004 Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary

[6] Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertility and Sterility. 2009;91(2):456-488.

[7] Carmina E, Legro RS, Stamets K, Lowell J, Lobo RA. Difference in body weight between American and Italian women with polycystic ovary syndrome: Influence of the diet.

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PCOs is also associated with elevated levels of plasma endothelin-1 (ET-1), one of several circulating indicators of endothelial injury and dysfunction. One study found that impairment of endothelial function is more severe in lean than obese women with PCOs, and that ET receptor downregulation plays an essential role in this probably adverse cardiovascular outcome [60].

The increase in carotid intima-media wall thickness (CIMT) in PCOs women has been associated in different studies with higher levels of insulin, hyperandrogenism, LDL level, and abdominal obesity; which is an early marker of atherosclerosis [61].

Meanwhile, impaired nitric oxide (NO) production as a consequence of elevated androgen levels in PCOs women contribute to endothelial dysfunction [62].

Elevated plasma viscosity as a result of increased plasma fibrinogen concentration in PCOs patients exacerbates vascular dysfunction because autoregulation of vasomotor tone may not be able to adjust with compromised physical properties of blood [63]. Some possible reasons for increased plasma fibrinogen are: increased inflammatory processes [64], decreased fibrinolysis [65], and as an acute phase reactant. Enhancement in fibrinogen level stimulates RBC aggregation and significantly increased resistance in blood flow [66]. Low SHBG and high insulin stimulate prothrombotic state in all of PCOs women by increased plasminogen activator inhibitor 1 (PAI-1) activity and fibrinogen in a BMI-independent way [67].

Dyslipidemia including elevated low-density lipoprotein (LDL), triglyceride levels and decreased high-density lipoprotein (HDL) are often seen in PCO women as a result of hyperandrogenism and insulin resistance in both lean and obese PCO patients [68].

Owing to many evidence about vitamin D deficiency and metabolic syndrome; there are many studies about 25(OH) D levels and PCOs. There are some evidences which support this relationship and encourage vitamin D administration in all of deficient PCOs women [69], whereas some studies do not support it [70].

From another site, insulin resistance, increased central adiposity, higher levels of testosterone, and dyslipidemia beside oxidative stress and low grade inflammation contribute to cause hepatic steatosis or fatty liver in PCOs women. Advanced stage of this disease characterized by necrosis and steatohepatitis which called non-alcoholic fatty liver disease (NAFLD) and has prevalence about 40% in lean PCOs women [71].

After blow-by-blow discussion about all of aspects in lean PCOs women, we cannot consider this syndrome as just a part of infertility or menstrual abnormality assessment, but should be accepted as an alarm sign for serious health problem.
