The association between triglycerides/high-density lipoprotein cholesterol ratio, insulin resistance, and serum androgen levels in patients with polycystic ovary syndrome

Abstract

Objectives: Insulin resistance and dyslipidemia are common comorbidities of polycystic ovary syndrome. We aim to evaluate the association between triglycerides/high-density lipoprotein cholesterol ratio, insulin resistance, and serum androgen levels in patients with polycystic ovary syndrome.

Methods: We enrolled a total of 40 polycystic ovary syndrome patients and 20 healthy control subjects in this cross-sectional study. The polycystic ovary syndrome patients were divided into two subgroups obese and non-obese. The triglycerides/high-density lipoprotein cholesterol ratio and homeostatic model assessment of insulin resistance were calculated for all individuals. Demographic characteristics, serum levels of metabolic parameters, and androgens were compared between the study subgroups. P-value < 0.05 was accepted as statistically significant.

Results: The triglycerides/high-density lipoprotein cholesterol ratio was higher in obese polycystic ovary syndrome patients than in other groups (3.64 ± 3.06 vs. 1.07 ± 0.36 in control and 1.18 ± 0.53 in non-obese group, p < 0.005). The triglycerides/high-density lipoprotein cholesterol ratio was positively correlated with homeostatic model assessment of insulin resistance (r=0.546, p < 0.001), total testosterone (r=0.402, p = 0.010), and free androgen index (r=0.609, p < 0.001) while was negatively correlated with sex hormone-binding globulin (r=-0.497, p = 0.001). Obese polycystic ovary syndrome patients had higher serum total testosterone levels, higher free androgen index, and lower sex hormone-binding globulin than non-obese polycystic ovary syndrome patients (0.71 ± 0.49 ng/mL vs. 0.45 ± 0.16 ng/mL, p = 0.006; 3.1 ± 1.91 vs. 1.01 ± 0.49, p < 0.005; and 26 ± 10.3 nmol/L vs. 59.6 ± 43.7 nmol/L, p < 0.005, respectively). Obese polycystic ovary syndrome patients had also worse lipid parameters, including high triglycerides and low high-density cholesterol when compared with other groups.

Conclusions: The triglycerides/high-density lipoprotein cholesterol ratio was correlated with the homeostatic model assessment of insulin resistance, and androgenic hormonal profiles including total testosterone and free androgen index in patients with polycystic ovary syndrome.

Keywords

• insulin resistance
• TG/HDL-C ratio
• hyperandrogenism
• obesity
• polycystic ovary syndrome

References

1. 1. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad HM, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013;98:4565-92.
2. 2. Apridonidze T, Essah PA, Luorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:1929-35.
3. 3. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165-74.
4. 4. Dunaif A, Madeli J, Fluh H. The impact of obesity and chronic hyperinsulinemia on gonadotropin release and gonadal steroid secretion in the polycystic ovary syndrome. J Clin Endocrinol Metab 1998;66:131-9.
5. 5. Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose intolerance in polycystic ovary syndrome-a position statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007;92:4546-56.
6. 6. Holzinger U, Kitzberger R, Fuhrmann V, Funk GC, Madl C, Ratheiser K. Correlation of calculated indices of insülin resistance (QUICKI and HOMA) with the euglycaemic hyperinsulinaemic clamp technique for evaluating insülin resistance in critically ill patients. Eur J Anaesthesiol 2007;24:966-70.
7. 7. Nur Zati Iwani AK, Jalaluddin MY, Wan Mohd Zin RM, Fuziah MZ, Hua Hong JY, Abqariyah Y, et al. TG/HDL-C ratio Is a good marker to identify children affected by obesity with increased cardiometabolic risk and insulin resistance. Int J Endocrinol 2019; 2019:8586167.
8. 8. Ebrahimi-Mamaghani M, Saghafi-Asl M, Pirouzpanah S, Aliasgharzadeh A, Aliashrafi S, Rezayi N, et al. Association of insulin resistance with lipid profile, metabolic syndrome, and hormonal aberrations in overweight or obese women with polycystic ovary syndrome. J Health Popul Nutr 2015;33:157-67.

9. 9. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res 1998;6 Suppl 2:51S.
10. 10. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 1:19-25.
11. 11. Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2012;18:146-70.
12. 12. Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol 2020;16:177-89.
13. 13. Veitch D. Where is the human waist? Definitions, manual compared to scanner measurements. Work 2012;41 Suppl 1:4018-24.
14. 14. Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstetrics Gynecol Survey 2004;59:141-54.
15. 15. Barber TM, McCarthy MI, Wass JA, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol 2006;65:137-45.
16. 16. Zavaroni I, Dall'Aglio E, Alpi O, Bruschi F, Bonora E, Pezzarossa A, et al. Evidence for an independent relationship between plasma insulin and concentration of high-density lipoprotein cholesterol and triglyceride. Atherosclerosis 1985;55:259-66.
17. 17. Anderwald C, Anderwald-Stadler M, Promintzer M, Prager G, Mandl M, Nowotny P, et al. The Clamp-Like Index: a novel and highly sensitive insulin sensitivity index to calculate hyperinsulinemic clamp glucose infusion rates from oral glucose tolerance tests in nondiabetic subjects. Diabetes Care 2007;30:2374-80.
18. 18. McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med 2003;139:802-9.
19. 19. Song do K, Lee H, Sung YA, Young Oh J. Triglycerides to high-density lipoprotein cholesterol ratio can predict impaired glucose tolerance in young women with polycystic ovary syndrome. Yonsei Med J 2016;57:1404-11.
20. 20. Greenwood EA, Huddleston HG. Insulin resistance in polycystic ovary syndrome: concept versus cut-off. Fertil Steril 2019;112:827-8.
21. 21. Ovesen P, Moller J, Ingerslev HJ, Jørgensen JO, Mengel A, Schmitz O, et al. Normal basal and insulin-stimulated fuel metabolism in lean women with the polycystic ovary syndrome. J Clin Endocrinol Metab 1993;77:1636-40.
22. 22. Taylor SI, Dons RF, Hernandez E, Roth J, Gorden P. Insulin resistance associated with androgen excess in women with autoantibodies to the insulin receptor. Ann Intern Med 1982;97:851-5.
23. 23. Barbieri RL, Smith S, Ryan KJ. The role of hyperinsulinemia in the pathogenesis of ovarian hyperandrogenism. Fertil Steril 1988;50:197-212.
24. 24. Zeng X, Xie YJ, Liu YT, Long SL, Mo ZC. Polycystic ovarian syndrome: correlation between hyperandrogenism, insulin resistance, and obesity. Clin Chim Acta 2020;502:214-21.
25. 25. Pasquali R, Antenucci D, Casimirri F, Venturoli S, Paradisi R, Fabbri R, et al. Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab 1989;68:173-9.
26. 26. Holte J, Bergh T, Gennarelli G, Wide L. The independent effects of polycystic ovary syndrome and obesity on serum concentrations of gonadotrophins and sex steroids in premenopausal women. Clin Endocrinol (Oxf) 1994;41:473-81.
27. 27. Wallace IR, McKinley MC, Bell PM, Hunter SJ. Sex hormone-binding globulin and insulin resistance. Clin Endocrinol (Oxf) 2013;78:321-9.
28. 28. Ain QU, Asif N, Alam A, Gilani M, Shahzad N, Sheikh W. Triglycerides-to-HDL-C ratio as a marker of cardiac disease and vascular risk factors in adults. J Coll Physicians Surg Pak 2019;29:1034-7.
29. 29. Keles N, Aksu F, Aciksari G, Yilmaz Y, Demircioglu K, Kostek O, et al. Is triglyceride/HDL ratio a reliable screening test for assessment of atherosclerotic risk in patients with chronic inflammatory disease? North Clin Istanb 2016;3:39-45.