C-reactive protein level and obesity as cardiovascular risk factors in polycystic ovary syndrome

Öz

Objective: To investigate the role of C-reactive protein (CRP) level elevation and obesity for the increased cardiovascular disease risk in polycystic ovary syndrome (PCOS). Methods: A hundred and nine patients with PCOS and 30 age matched healthy volunteers with regular menstrual cycle are involved in the study. PCOS group is further subdivided into three subgroups according to the body mass index (BMI). Subgroups included 54 with BMI30. Blood samples for glucose, insulin, uric acid, and CRP were collected in the morning after overnight fasting (12 hours). Homeostasis model assessment-insulin resistance (HOMA-IR) was calculated. Results: Fasting blood glucose, insulin, and HOMA-IR was significantly higher in PCOS group (p=0.02, p=0.01 and p=0.02). CRP level was higher in subgroup with BMI>30. High CRP level in PCOS was found to be independent from BMI (p30. When compared with the control group high insulin level was the only to be statistically significant in obese PCOS patients (p=0.005). HOMA-IR was higher in PCOS subgroup with BMI>30 when compared with controls and the PCOS subgroup with BMI

Anahtar Kelimeler

• PCOS, CRP, obesity, cardiovascular risk

Polikistik over sendromunda kardiyovasküler hastalık risk faktörü olarak C-reaktif protein düzeyi ve obezite

Öz

Amaç: Bu çalışmada PKOS lu hastalarda kardiyovasküler hastalık risk faktörü olarak obesite ve C-reaktif protein (CRP) seviyesinin artışını değerlendirmeyi amaçladık. Yöntemler: Çalışmamıza 109 PKOS\'lu ve kontrol grubu olarak benzer yaş grubundan 30 sağlıklı düzenli menstrüel siklusu olan Vücut Kitle İndeksi (VKI) 18,5-25 kg/m2 arası kadın hasta dahil edildi. PKOS\'lu 109 hasta VKI\'ne göre 3 alt gruba ayrıldı. VKI 30 de olan 33 hasta çalışmada yer aldı. Hastaların 12 saat açlık sonrası sabah kan glikoz, insülin, ürik asit ve CRP düzeyleri bakıldı. HOMA-IR (Homeostatic model assesment-insulin resistance) indeksi hesaplandı. Bulgular: Açlık kan şekeri, insülin ve HOMA-IR değerleri PKOS grubunda anlamlı şekilde yüksek bulundu (p=0.02, p=0.01 ve p=0.02). VKI> 30 olanlarda CRP düzeyleri anlamlı olarak yüksek bulundu. CRP deki bu anlamlı yükseklik VKİ den bağımsız olarak saptandı (p30 olan PKOS\'lu grupta HOMA-IR indeksi ve insülin düzeyleri diğer gruplara göre daha yüksek bulundu. Kontrol grubu ile karşılaştırıldığında insulin yüksekliği sadece obez grupta istatistiksel olarak anlamlı bulundu (p=0,005). VKİ >30 olan PKOS\'lu grupta kontrol ve VKİ

Anahtar Kelimeler

• PKOS, CRP, obezite, kardiyovasküler risk

Kaynakça

1. Dunaif A. Insulin resistance and the polycystic ovary syn- drome: mechanism and implications for pathogenesis. En- docr Rev 1997;18:774-800.
2. Knochenhauer ES, Key TJ, Kahsar-Miller M, et al. Preva- lence of the polycystic ovary syndrome in unselected black and white women of the South eastern United States: a prospective study. J Clin Endocrinol Metab 1998;83:3078- 3082.
3. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, et al. A sur- vey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab 1999;84:4006-4011.
4. Wild RA. Polycystic ovary syndrome: a risk for coronary artery disease? Am J Obstet Gynecol 2002;186:35-43.
5. Pierpoint T, McKeigue PM, Isaacs AJ, et al. Mortality of women with polycystic ovary syndrome at long term fol- low-up. J Clin Epidemiol 1998;51:581-586.
6. Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long- term follow-up: a retrospective cohort study. Clin Endocri- nol (Oxf) 2000;52:595-600.
7. Blake GJ, Ridker PM. Inflammatory bio-markers and cardio- vascular risk prediction. J Intern Med 2002;252:283-294.
8. Boulman N, Levy Y, Leiba R, et al. Increased C-reactive protein levels in the polycystic ovary syndrome: A mark- er of cardiovascular disease. J Clin Endocrinol Metab 2004;89:2160-2165.

9. Gündüz G, Karaalp E, Süer N. The relationship between chronic inflammatory indicators that shows the risk of car- diovascular disease and HOMA-IR in patients with poly- cystic ovary syndrome. Turkiye Klinikleri J Gynecol Obst 2012;22:1027-1029.
10. Poretsky L. On the paradox of insulin-induced hyper- androgenism in insulin-resistant states. Endocr Rev 1991;12:3-13.
11. Kirschner MA, Samojik E, Drejda M, et al. Androgen-es- trogen metabolism in women with upper body versus lower body obesity. J Clin Endocrinol Metab 1990;70:473-479.
12. Ostlund Jr RE, Staten M, Kuhrt W, et al. The ratio of waist- to-hip circumference, plasma insulin level, and glucose in- tolerance as independent predictors for the HDL2 cholester- ol level in older adults. New Engl J Med 1990;25;322:229- 234.
13. Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related topolycystic ova- ry syndrome (PCOS). Hum Reprod 2004;19:41-417.
14. Legro RS, Finegood D, Dunaif A. A fasting glucose to insu- lin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1998;83:2694-2698.
15. Schachter M, Raziel A, Friedler S, et al. Insulin Resistance in patients with polycystic ovary syndrome is associated with elevated homocysteine. Hum Reprod. 2003:18;721- 727.
16. Craig LB, Ke RW, Kutteh WH. Increased prevalance of in- sulin resistance in women with a history of recurrent preg- nancy loss. Fertil Steril 2002;78:487-490.
17. Whayne TF Jr. Atherosclerosis: current status of prevention and treatment. Int J Angiol 211;20:213-222.
18. Vilmann LS, Thisted E, Baker JL, Holm JC. Development of Obesity and Polycystic Ovary Syndrome in Adolescents. Horm Res Paediatr 2012 Nov 28. DOI: 10.1159/000345310
19. Dunaif A, Graf M, Mandeli J, et al. Characterization of groups of hyperandrogenic women with acanthosis nigri- cans, impaired glucose tolerance, and/or hyperinsulinemia. J Clin Endocrinol Metab 1987;65:499-507.
20. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity in polycystic ovary syndrome. Diabetes 1989;38:1165-1174.
21. Ridker PM, Rifai N, Rose L, et al. Comparison of C-reac- tive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002;347:1557-1565.
22. Kelly CC, Lyall H, Petrie JR, et al. Low grade chronic in- flammation in women with polycystic ovarian syndrome. J Clin Endocrinol Metab 2001;86:2453-2455.
23. Engeli S, Feldpausch M, Gorzelniak K, et al. Association between adiponectin and mediators of inflammation in obese women. Diabetes 2003;52:942-927.
24. Festa A, D’Agostino R Jr, Howard G, et al. Chronic sub- clinical inflammation as part of the insulin resistance syndrome: The Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000;102:42-47.
25. Fernandez-Real JM, Vayreda M, Richart C, et al. Circulat- ing interleukin-6 levels, blood pressure, and insulin sensi- tivity in apparently healthy men and women. J Clin Endo- crinol Metab 2001;86:1154-1159.
26. Boulman N, Levy Y, Leiba R. Increased C-reactive protein levels in the polycystic ovary syndrome: a marker of cardio- vascular disease. J Clin Endocrinol Metab 2004;89:2160- 2165.
27. Rouru J, Anttila L, Koskinen P. Serum leptin concentrations in women with polycystic ovary syndrome. J Clin Endocri- nol Metab 1997;82:1697-1700.
28. Gennarelli G, Holte J, Wide L, et al. Is there a role for leptin in the endocrine and metabolic aberrations of polycystic ovary syndrome? Hum Reprod 1998;13:535-541.
29. Samy N, Hashim M, Sayed M, Said M. Clinical significance of inflammatory markers in polycystic ovary syndrome: their relations hipto insulin resistance and body mass index. Disease Markers 2009;26:163-170.
30. Puder JJ, Varga S, Kraenzlin M, et al. Central fat excess in polycystic ovary syndrome: relation to low-grade inflam- mation and insulin resistance. J Clin Endocrinol Metab 2005;90:6014-6021.
31. Panidis D, Kourtis A, Farmakiotis D, Mouselech T, Rousso D, Koliakos G. Serum adiponectin levels in women with poly- cystic ovary syndrome. Hum Reprod 2003;18: 1790-1796.
32. Bideci A, Camurdan MO, Yeşilkaya E, et al. Serum ghrelin, leptin and resistin levels in adolescent girls with polycystic ovary syndrome. J Obstet Gynecol Res 2008;34:578-584.
33. Tsouli SG, Liberopoulos EN, Mikhailidis DP, et al. El- evated Serum Uric acid levels in Metabolic Syndrome: An active component or innocent by stander? Metabolism 2006;55:1293-1301.