Comparison of cardiovascular markers and variability of insulin resistance in women with anovulatory and ovulatory polycystic ovary syndrome
Li Wei Cho1,2, Eric Kilpatrick1, Brian Keavil3, Vijay Jayagopal4, Anne Marie Coady5 & Stephen Atkin1
Objective: We aim to study whether a difference exists in cardiovascular risk and variability of IR within the hyperandrogenic group of women with PCOS who are ovulatory and anovulatory.
Method: Fifty-three women with PCOS were recruited. All subjects were diagnosed to have PCOS by the ESHRE/ASRM Rotterdam criteria where all patients had evidence of biochemical hyperandrogenism and hirsutism, chronic anovulation and polycystic ovaries on transvaginal ultrasound. Non classical 21-hydroxylase deficiency, hyperprolactinemia, and androgen secreting tumours were excluded prior to diagnosis of PCOS. Diabetes was excluded by OGTT test. All subjects gave their informed written consent prior to entering the study. Fasting venous blood was collected at the same time each day (08000900) on 10 consecutive occasions at 34 day intervals to include measurements over a period of 5 weeks that included at least a complete menstrual cycle. Ovulation was defined by a progesterone level >20 nmol/l. Statistical calculations were done using SPSS version 16.0 and Mann Whitney test was used for non parametric comparisons.
Results: Analysis of progesterone levels showed twenty two of fifty three women with PCOS to have had an ovulatory cycle (42%). Women with anovulatory PCOS have higher variability of IR compared to those having an ovulatory cycle (5.9±4.8 vs 1.0±0.4). Mean IR was also higher in anovulatory PCOS but did not reach statistical significance (4.7±0.2 vs 3.9±0.1). There was no significant difference in BMI. Hs-CRP was higher in anovulatory PCOS but did not reach statistical significance (7.19±0.56 vs 4.56±0.37). Triglyceride is significantly higher and HDL lower in anovulatory PCOS but surprisingly LDL is higher in the ovulatory group.
Conclusion: Women with anovulatory PCOS have higher mean and biological variability of IR as well as increased markers for cardiovascular disease suggesting that they may be at higher risk compared to those with ovulatory PCOS.