Metabolic syndrome in patients with the polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is frequently characterized by abdominal obesity and insulin resistance, which also represent the hallmarks of the metabolic syndrome (MetS). It is well established that MetS is associated with increased risk for both Type 2 diabetes mellitus and cardiovascular disease (CVD) and accumulating data suggest that PCOS is also a risk factor for Type 2 diabetes mellitus and CVD. Accordingly, the association of PCOS with MetS has major health care implications given also the high prevalence of both disorders. We aimed to critically analyze the major studies that compared the prevalence of MetS between women with PCOS and controls, to discuss the anthropometric, endocrine and metabolic characteristics of PCOS, which are implicated in the pathogenesis of Mets in women with PCOS and to comment on the implications and management of MetS in this population. We thus summarize the evidence regarding the prevalence of MetS in PCOS and discuss the primary determinants driving this association. Current evidence shows that MetS is frequently observed in women with PCOS, but this appears to be mainly due to the more pronounced abdominal obesity in these women and not due to PCOS per se. Lifestyle changes are the treatment of choice for MetS in women with PCOS, whereas pharmacotherapy should be individualized.

Keywords::

• age
• diagnostic criteria
• insulin resistance
• metabolic syndrome
• obesity
• phenotype
• polycystic ovary syndrome

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Metabolic syndrome (MetS) is more prevalent in women with polycystic ovary syndrome (PCOS) than in control women.

• • The higher prevalence of MetS in women with PCOS appears to be mostly due to the more severe abdominal obesity in these women and not to PCOS per se.

• • MetS appears to be more frequent in women with PCOS who have both oligo- or anovulation and clinical and/or biochemical hyperandrogenism than in women with PCOS with only one of features.

• • Women with both MetS and PCOS have more pronounced insulin resistance than women with only PCOS, but it is unclear whether MetS increases the risk for Type 2 diabetes mellitus or cardiovascular disease in women with PCOS.

• • Lifestyle changes are the cornerstone of management of women with PCOS who have MetS.

• • Pharmacotherapy of hypertension, dyslipidemia and impaired glucose metabolism should be individualized in these women.

Notes