Polycystic ovary syndrome (PCOS) affects more than 5% of women in reproductive age and is characterized by a heterogeneous spectrum of oligoanovulation and biochemical or clinical evidence of hyperandrogenism. Insulin resistance and compensatory hyperinsulinaemia play a significant role in pathogenesis of PCOS.
Chronic low level inflammation and an increased risk for cardiovascular disease and type2-diabetes are reported in women with PCOS.
Women with PCOS (n=68) and age- and body mass index-matched healthy women (n=30) with regular menses and no signs of hyperandrogenism were investigated.
PCOS patients (n=27) accepting participation in our study were treated with metformin (850 mg twice daily). Metabolic, endothelial and endocrine markers including OGTT were investigated in all women and in the treatment group before and after 6 months on metformin. In addition intima media thickness (IMT) as surrogate marker of cardiovascular disease was measured. Among the endothelial markers we were particular interested in the concentration of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase and independent risk factor for cardiovascular morbidity and mortality.
Levels of asymmetric dimethylarginine (ADMA), androgens, hs-CRP and proinflammatory cytokines (IL-6, IL-18) were significantly increased in women with PCOS and were found to be positively correlated with parameters of insulin sensitivity (HOMA-IR and AUCinsulin0120 min).
Treatment with metformin positively affected metabolic and endocrine profile as well as menstrual function and led to spontaneous pregnancies.
In conclusion, our data show that women with PCOS have elevated levels of inflammatory and endothelial markers, that was partly reversed after a 6 month metformin treatment.