Cardiometabolic health in premature ovarian insufficiency

Abstract

Premature ovarian insufficiency (POI) is an increasing public health problem with a prevalence now approaching 4%. POI results in adverse effects on the skeleton and central nervous system as well as disturbances of metabolic and cardiological factors that predispose to a major increased risk of cardiovascular disease (CVD). This article reviews the effects of the premature loss of ovarian function on lipids and lipoproteins, glucose and insulin metabolism, body composition, hemostasis and blood pressure, together with effects on the development of metabolic syndrome and diabetes mellitus. The article examines the effects of POI on vascular endothelial function and inflammation that result in arterial disease, and reviews the effects of hormone replacement therapy (HRT) on these various metabolic processes and on cardiovascular outcomes. It is essential that women with POI receive hormonal treatment to help prevent the development of CVD, and that this treatment is continued at least until the normal age of menopause. It appears that HRT has a more favorable effect than the combined oral contraceptive, but larger clinical trials are needed to establish the optimal treatment. Other therapeutic measures may need to be added to correct existing metabolic abnormalities and, in particular, attention to lifestyle factors such as diet and exercise must be encouraged.

早发性卵巢功能不全的心脏代谢健康 摘要

早发性卵巢功能不全（POI）是一个日益严重的公共健康问题, 其患病率现已接近4%。POI对骨骼和中枢神经系统导致不良影响, 以及代谢和心血管因素的紊乱, 使心血管疾病(CVD)的风险大大增加。本文就卵巢功能过早减退对血脂和脂蛋白、葡萄糖和胰岛素代谢、体成分、凝血和血压的影响以及对代谢综合征和糖尿病发展的影响作一综述。探讨了POI对血管内皮功能及导致动脉疾病的炎症反应的影响, 并论述了激素替代治疗(HRT)对这些代谢过程和心血管结果的影响。重要的是, 患有POI的女性接受激素治疗, 可以帮助防止CVD的发展, 这种治疗至少要持续到正常绝经的年龄。HRT似乎比复方口服避孕药有更好的效果, 但还需要更大规模的临床试验来确定最佳的治疗方法。需要增加其他治疗措施来纠正现有的代谢异常, 特别是注意饮食和锻炼等生活方式, 这是必须被鼓励的。

Keywords:

• Premature ovarian insufficiency
• lipids
• glucose and insulin
• body composition
• hemostasis
• metabolic syndrome
• diabetes mellitus
• blood pressure
• endothelial function
• inflammation
• atherosclerosis
• hormone replacement therapy

Potential conflict of interest

J. C. Stevenson reports grants from Abbott, Mylan and Pfizer, and personal fees from Abbott, Bayer, Gideon Richter, Menarini, Mitsubishi Tanabe, Mylan and Pfizer, outside the submitted work. N. Panay has lectured and/or acted in an advisory capacity for Abbott, Bayer, Besins, Lawley, Mithra, Mylan, Novo Nordisk, Roche Diagnostics, SeCur, Serelys, Shionogi, Theramex, Viatris and the Yes Company. P. Collins has received grant funding from the Victor Phillip Dahdaleh Charitable Foundation. H. Hamoda, I. Lambrinoudaki, K. Maclaran and A. H. E. M. Maas have no disclosures.

Source of funding

Nil.