Background: Polycystic ovary syndrome (PCOS) and non-alcoholic fatty liver disease (NAFLD) are both associated with the metabolic syndrome and are each associated with increased cardiovascular risk. Endothelial function, an early feature in the development of atherosclerosis, has been shown to be abnormal in both PCOS and NAFLD.
The aim of this study was to determine if NAFLD conferred additional cardiovascular risk compared to PCOS alone.
Method: Twelve patients with PCOS alone and 10 patients who were matched for age, free androgen index and menstrual cycle irregularity were recruited.
Patients were diagnosed with PCOS as per Rotterdam criteria. The PCOS alone group had a normal liver ultrasound scan and normal liver function tests. The PCOS-NAFLD group had a histological diagnosis of steatosis or steatohepatitis. Other known aetiological factors of chronic liver disease (including alcohol intake more than 20 g/day) were excluded.
The patients attended after an overnight fast and endothelial function (RH-PAT) as determined using peripheral arterial tonometry (endoPAT 2000). Anthropometric and blood samples were subsequently taken.
Results: There was no difference between the PCOS-NAFLD and PCOS groups with respected to systolic (125.20±13.73 vs 116.67±9.55 P=0.15) or diastolic (72.80±12.93 vs 71.00±5.90 P=0.21) blood pressure. Cholesterol (4.67±0.68 vs 4.51±0.78 P=0.68), HDL (1.13±0.52 vs 1.09±0.26 P=0.60), LDL 2.96±0.70 vs 2.89±0.70 P=0.93) and triglycerides (1.58±0.68 vs 1.19±0.43 P=0.46) were no different between the two groups. The PCOS-NAFLD group had a higher body mass index (BMI) (43.72±9.78 vs 37.47±3.87 P=0.03) with increased waist (128.60±15.14 vs 113.54±9.11 P=0.01) and hip (135.85±12.86 vs 123.35±9.14 P=0.01) circumference. There was no difference in RH-PAT between the PCOS-NAFLD and PCOS groups (1.91±0.39 vs 1.80±0.45 P=0.38).
Conclusion: This study suggests that additional fatty liver disease in PCOS does not confer additional cardiovascular risk compared to PCOS alone, and despite the PCOS-NAFLD group having a higher BMI.