Incidence of prediabetes and risk of developing cardiovascular disease in women with polycystic ovary syndrome

  • Zelija Velija-Asimi Department of Nuclear Medicine and Endocrinology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  • Azra Burekovic Department of Nuclear Medicine and Endocrinology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  • Tanja Dujic Department of Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  • Amela Dizdarevic-Bostandzic Department of Nuclear Medicine and Endocrinology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  • Sabina Semiz Natural Sciences Department, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Keywords: Prediabetes incidence, cardiovascular disease, polycystic ovary syndrome

Abstract

Our aim was to determine the incidence of prediabetes and risk of developing cardiovascular disease (CVD) in women with polycystic ovary syndrome (PCOS). This prospective, observational study included 148 women with PCOS, without Type 2 diabetes mellitus (T2DM) and CVD present at baseline. In the fasting blood samples, we measured lipids, glucose, and insulin levels during oral glucose tolerance test, levels of C-reactive protein (CRP), steroids, 25-hydroxyvitamin D (25-OHD), prolactin, thyroid-stimulating hormone, and parathyroid hormone. The follow-up period was 3 years. At baseline, prevalent prediabetes was present in 18 (12%) of PCOS cases and it progressed to T2DM in 5 (3%) of the cases. Incident prediabetes during the follow-up was noted in 47 (32%) women or 4.7 per 1000 persons/year. Prediabetes was associated with elevated body mass index (BMI) (odds ratio [OR] = 1.089, confidence interval [CI]: 1.010; 1.174, p = 0.026), high baseline levels of CRP (OR = 3.286, CI: 1.299; 8.312, p = 0.012), homeostatic model assessment - insulin resistance (IR) (OR = 2.628, CI: 1.535; 4.498, p < 0.001), and high lipid accumulation product (LAP) (OR = 1.009, CI: 1.003; 1.016, p = 0.005). Furthermore, prediabetes was associated with low 25-OHD (OR = 0.795, CI: 0.724; 0.880, p ≤ 0.05). In addition, cardiovascular risk in PCOS women with prediabetes was high (hazard ratio = 1.092, CI: 1.036; 1.128, p < 0.001). We showed association of prediabetes with high BMI, IR, markers of inflammation, LAP, and low serum 25-OHD concentration. IR appears to be more relevant than the other predictors of prediabetes risk in this study. PCOS women are considered as a high-risk population for prediabetes.

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Author Biographies

Zelija Velija-Asimi, Department of Nuclear Medicine and Endocrinology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Department of Nuclear Medicine and Endocrinology
Azra Burekovic, Department of Nuclear Medicine and Endocrinology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Department of Nuclear Medicine and Endocrinology
Tanja Dujic, Department of Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Department of Biochemistry and Clinical Analysis
Amela Dizdarevic-Bostandzic, Department of Nuclear Medicine and Endocrinology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Department of Nuclear Medicine and Endocrinology
Sabina Semiz, Natural Sciences Department, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Natural Sciences Department

References

Nitsche K, Ehrmann DA. Obstructive sleep apnea and metabolic dysfunction in polycystic ovary syndrome. Best Pract Res Clin Endocrinol Metab 2010;24(5):717-30. http://dx.doi.org/10.1016/j.beem.2010.08.001.

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. J Clin Endocrinol Metab 2004;89(6):2745-9. http://dx.doi.org/10.1210/jc.2003-032046.

Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, Type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update 2010;16(4):347-63. http://dx.doi.org/10.1093/humupd/dmq001.

Cho LW, Randeva HS, Atkin SL. Cardiometabolic aspects of polycystic ovarian syndrome. Vasc Health Risk Manag 2007;3(1):55-63.

Cussons AJ, Stuckey BG, Watts GF. Metabolic syndrome and cardiometabolic risk in PCOS. Curr Diab Rep 2007;7(1):66-73. http://dx.doi.org/10.1007/s11892-007-0012-8.

Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: A consensus statement by the androgen excess and polycystic ovary syndrome (AE-PCOS) society. J Clin Endocrinol Metab 2010;95(5):2038-49. http://dx.doi.org/10.1210/jc.2009-2724.

Tomlinson J, Millward A, Stenhouse E, Pinkney J. Type 2 diabetes and cardiovascular disease in polycystic ovary syndrome: What are the risks and can they be reduced? Diabet Med 2010;27(5):498-515. http://dx.doi.org/10.1111/j.1464-5491.2010.02994.x.

Dehghan A, Kardys I, de Maat MP, Uitterlinden AG, Sijbrands EJ, Bootsma AH, et al. Genetic variation, C-reactive protein levels, and incidence of diabetes. Diabetes 2007;56(3):872-8. http://dx.doi.org/10.2337/db06-0922.

Keskin Kurt R, Okyay AG, Hakverdi AU, Gungoren A, Dolapcioglu KS, Karateke A, et al. The effect of obesity on inflammatory markers in patients with PCOS: A BMI-matched case-control study. Arch Gynecol Obstet 2014;290(2):315-9. http://dx.doi.org/10.1007/s00404-014-3199-3.

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(1):41-7. http://dx.doi.org/10.1093/humrep/deh098.

Blume-Peytavi U, Blumeyer A, Tosti A, Finner A, Marmol V, Trakatelli M, et al. S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents. Br J Dermatol 2011;164(1):5-15.

http://dx.doi.org/10.1111/j.1365-2133.2010.10011.x.

Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961;21:1440-7.

http://dx.doi.org/10.1210/jcem-21-11-1440.

Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34(28):2159-219. http://dx.doi.org/10.1093/eurheartj/eht151.

International Diabetes Federation. The IDF consensus worldwide definition of metabolic syndrome. Brussels: International Diabetes Federation; 2006.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28(7):412-9. http://dx.doi.org/10.1007/BF00280883.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37(Suppl 1):S81-90.

Handelsman Y, Mechanick JI, Blonde L, Grunberger G, Bloomgarden ZT, Bray GA, et al. American association of clinical endocrinologists medical guidelines for clinical practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract 2011;17(Suppl 2):1-53. http://dx.doi.org/10.4158/EP.17.S2.1.

American Diabetes Association. Standards of medical care in diabetes – 2013. Diabetes Care 2013;36(Suppl 1):S11-66. http://dx.doi.org/10.2337/dc13-S011.

Garber AJ, Handelsman Y, Einhorn D, Bergman DA, Bloomgarden ZT, Fonseca V, et al. Diagnosis and management of prediabetes in the continuum of hyperglycemia: When do the risks of diabetes begin? A consensus statement from the American college of endocrinology and the American association of clinical endocrinologists. Endocr Pract 2008;14(7):933-46. http://dx.doi.org/10.4158/EP.14.7.933.

Kahn HS. The “lipid accumulation product” performs better than the body mass index for recognizing cardiovascular risk: A population-based comparison. BMC Cardiovasc Disord 2005;5(1):26. http://dx.doi.org/10.1186/1471-2261-5-26.

Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, et al. The polycystic ovary syndrome: A position statement from the European society of endocrinology. Eur J Endocrinol 2014;171(4):P1-29. http://dx.doi.org/10.1530/EJE-14-0253.

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(1):165-9. http://dx.doi.org/10.1097/00006254-199906000-00019.

Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999;22(1):141-6. http://dx.doi.org/10.2337/diacare.22.1.141.

Legro RS, Gnatuk CL, Kunselman AR, Dunaif A. Changes in glucose tolerance over time in women with polycystic ovary syndrome: A controlled study. J Clin Endocrinol Metab 2005;90(6):3236-42. http://dx.doi.org/10.1210/jc.2004-1843.

Rachon D, Teede H. Ovarian function and obesity - Interrelationship, impact on women's reproductive lifespan and treatment options. Mol Cell Endocrinol 2010;316(2):172-9. http://dx.doi.org/10.1016/j.mce.2009.09.026.

Lerchbaum E, Schwetz V, Giuliani A, Obermayer-Pietsch B. Influence of a positive family history of both Type 2 diabetes and PCOS on metabolic and endocrine parameters in a large cohort of PCOS women. Eur J Endocrinol 2014;170(5):727-39. http://dx.doi.org/10.1530/EJE-13-1035.

Smith-Marsh D. Pharmacological strategies for preventing Type 2 diabetes in patients with impaired glucose tolerance. Drugs Today (Barc) 2013;49(8):499-507. http://dx.doi.org/10.1358/dot.2013.49.8.2002839.

Huang J, Ni R, Chen X, Huang L, Mo Y, Yang D. Metabolic abnormalities in adolescents with polycystic ovary syndrome in South China. Reprod Biol Endocrinol 2010;8:142. http://dx.doi.org/10.1186/1477-7827-8-142.

Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: Purposes and pitfalls. Obstet Gynecol Surv 2004;59(2):141-54. http://dx.doi.org/10.1097/01.OGX.0000109523.25076.E2.

Diamanti-Kandarakis E, Papavassiliou AG. Molecular mechanisms of insulin resistance in polycystic ovary syndrome. Trends Mol Med 2006;12(7):324-32. http://dx.doi.org/10.1016/j.molmed.2006.05.006.

Badawi A, Klip A, Haddad P, Cole DE, Bailo BG, El-Sohemy A, et al. Type 2 diabetes mellitus and inflammation: Prospects for biomarkers of risk and nutritional intervention. Diabetes Metab Syndr Obes 2010;3:173-86. http://dx.doi.org/10.2147/DMSO.S9089.

Wehr E, Gruber HJ, Giuliani A, Möller R, Pieber TR, Obermayer-Pietsch B. The lipid accumulation product is associated with impaired glucose tolerance in PCOS women. J Clin Endocrinol Metab 2011;96(6):E986-90. http://dx.doi.org/10.1210/jc.2011-0031.

Wiltgen D, Benedetto IG, Mastella LS, Spritzer PM. Lipid accumulation product index: A reliable marker of cardiovascular risk in polycystic ovary syndrome. Hum Reprod 2009;24(7):1726-31. http://dx.doi.org/10.1093/humrep/dep072.

Roa Barrios M, Arata-Bellabarba G, Valeri L, Velázquez-Maldonado E. Relationship between the triglyceride/high-density lipoprotein-cholesterol ratio, insulin resistance index and cardiometabolic risk factors in women with polycystic ovary syndrome. [Article in Spanish]. Endocrinol Nutr 2009;56(2):59-65. http://dx.doi.org/10.1016/S1575-0922(09)70553-4.

de las Heras J, Rajakumar K, Lee S, Bacha F, Holick MF, Arslanian SA. 25-hydroxyvitamin D in obese youth across the spectrum of glucose tolerance from normal to prediabetes to Type 2 diabetes. Diabetes Care 2013;36(7):2048-53. http://dx.doi.org/10.2337/dc12-1288.

Shankar A, Sabanayagam C, Kalidindi S. Serum 25-hydroxyvitamin d levels and prediabetes among subjects free of diabetes. Diabetes Care 2011;34(5):1114-9. http://dx.doi.org/10.2337/dc10-1203.

Thomson RL, Spedding S, Buckley JD. Vitamin D in the aetiology and management of polycystic ovary syndrome. Clin Endocrinol (Oxf) 2012;77(3):343-50. http://dx.doi.org/10.1111/j.1365-2265.2012.04434.x.

Li HW, Brereton RE, Anderson RA, Wallace AM, Ho CK. Vitamin D deficiency is common and associated with metabolic risk factors in patients with polycystic ovary syndrome. Metabolism 2011;60(10):1475-81. http://dx.doi.org/10.1016/j.metabol.2011.03.002.

Carmina E, Campagna AM, Lobo RA. Emergence of ovulatory cycles with aging in women with polycystic ovary syndrome (PCOS) alters the trajectory of cardiovascular and metabolic risk factors. Hum Reprod 2013;28(8):2245-52. http://dx.doi.org/10.1093/humrep/det119.

Published
2016-11-10
How to Cite
1.
Velija-Asimi Z, Burekovic A, Dujic T, Dizdarevic-Bostandzic A, Semiz S. Incidence of prediabetes and risk of developing cardiovascular disease in women with polycystic ovary syndrome. Bosn J of Basic Med Sci [Internet]. 2016Nov.10 [cited 2019Oct.22];16(4):298-06. Available from: https://bjbms.org/ojs/index.php/bjbms/article/view/1428
Section
Translational and Clinical Research

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