Effect of Metformin on Homocysteine Levels in Lean PCOS Patients

Öz

Aim: Increased levels of homocysteine have been considered as a significant risk factor for cardiovascular disease. Elevated levels have been demonstrated in polycystic ovary syndrome (PCOS) patients, and have been found to be associated with insulin resistance in PCOS. This study aimed to determine the basal homocysteine levels and insulin sensitivity status in previously untreated lean PCOS patients and to evaluate the effect of metformin as a long term treatment modality. Material and Methods: Twenty-five lean (BMI <25kg/m2) patients with PCOS were recruited to the study. Metformin 500mg orally twice daily was administered for 6 months. Before and after initiation of the study, after 12h fasting, homocysteine, insulin, glucose, FSH, LH, estradiol, progesterone, prolactin, free testosterone levels were measured and 75g OGTTs were performed. Normality was assessed with the Shapiro-Wilk test. Paired Student’s t-test or Wilcoxon signed-rank test was used as appropriate, categorical variables were analyzed with the McNemar test, and correlations were evaluated with Spearman analysis (p<0.05). Results: Pre-treatment (pre) and posttreatment (post) homocysteine levels were within normal levels (median (min-max)) (pre:6.1μmol/L (1.2-25.3), post: 6.2μmol/L (2.0-20.0), p=0.59). Metformin treatment significantly reduced fasting blood glucose (pre:93.7±9.6mg/dL; post:84.8±8.8mg/dL, p=0.003), fasting insulin (pre: 18.1±9.5μU/mL; post: 12.3±5.2μU/mL, p=0.02), and logHOMA (pre: 0.59±0.16, post: 0.37±0.17, p<0.001) values. Conclusion: Homocystein levels were within normal range in previously untreated lean PCOS patients. Insulin resistance was present in significant proportion of patients which also decreased after treatment. However, metformin treatment had no significant effect on homocysteine values.

Anahtar Kelimeler

• Homocysteine
• Insulin resistance
• Metformin
• PCOS

Etik Beyan

2003/03-3. 03.04.2003

Metforminin Zayıf PKOS Hastalarında Homosistein Düzeyleri Üzerindeki Etkisi

Öz

Amaç: Homosistein düzeylerindeki artış kardiyovasküler hastalıklar için önemli bir risk faktörü olarak kabul edilmektedir. Polikistik over sendromu (PKOS) hastalarında yüksek düzeyler gösterilmiş ve PKOS’ta insülin direnci ile ilişkili olduğu bildirilmiştir. Bu çalışmanın amacı, daha önce tedavi görmemiş zayıf PKOS hastalarında bazal homosistein düzeylerini ve insülin duyarlılığını belirlemek ve metforminin uzun süreli bir tedavi yöntemi olarak etkisini değerlendirmektir. Gereç ve Yöntemler: Yirmi beş zayıf (VKİ <25 kg/m²) PKOS hastası çalışmaya dahil edildi. Metformin 500 mg oral yoldan günde iki kez 6 ay boyunca uygulandı. Çalışmanın başlangıcında ve 6. ayda, 12 saatlik açlık sonrası homosistein, insülin, glikoz, FSH, LH, östradiol, progesteron, prolaktin ve serbest testosteron düzeyleri ölçüldü ve 75 g OGTT yapıldı. Verilerin normal dağılıma uygunluğu Shapiro- Wilk testi ile değerlendirildi. Parametrik veriler eşleştirilmiş Student t-testi, nonparametrik veriler Wilcoxon işaretli sıralar testi ile analiz edildi. Kategorik değişkenler McNemar testi ile karşılaştırıldı; korelasyon analizlerinde Spearman testi kullanıldı (p<0,05 anlamlı kabul edildi). Bulgular: Tedavi öncesi ve sonrası homosistein düzeyleri normal seviyelerdeydi (medyan (min-maks)) (öncesi: 6,1 μmol/L (1,2-25,3), sonrası: 6,2 μmol/L (2,0-20,0), p=0,59). Metformin tedavisi açlık kan şekeri (öncesi: 93,7 ± 9,6 mg/dL; sonrası: 84,8 ± 8,8 mg/dL, p=0,003), açlık insülin (öncesi: 18,1 ± 9,5 μU/mL; sonrası: 12,3 ± 5,2 μU/mL, p=0,02) ve logHOMA (öncesi: 0,59 ± 0,16, sonrası: 0,37 ± 0,17, p<0,001) değerlerini anlamlı şekilde azalttı. Sonuç: Daha önce tedavi görmemiş zayıf PKOS hastalarında homosistein düzeyleri normal sınırlardaydı. Hastaların önemli bir kısmında insülin direnci mevcuttu ve metformin tedavisi sonrasında bu direnç belirgin olarak azaldı. Ancak metformin tedavisinin homosistein düzeyleri üzerinde anlamlı bir etkisi olmadı.

Anahtar Kelimeler

• Homosistein
• Polikistik over sendromu
• Metformin
• İnsulin direnci

Etik Beyan

2003/03-3. 03.04.2003

Kaynakça

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