Milder forms of atherogenic dyslipidemia in ovulatory versus anovulatory polycystic ovary syndrome phenotype. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. Efficacy of metformin in obese and non-obese women with polycystic ovary syndrome: a randomized, double-blinded, placebo-controlled cross-over trial. Endothelial dysfunction in PCOS: role of obesity and adipose hormones. Effects of exercise and nutritional counseling in women with polycystic ovary syndrome. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. Risk of T2DM and impaired fasting glucose among pcos subjects: Results of an 8-year follow-up Effect of sibutramine on weight reduction in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Association between Polycystic Ovaries and Extent of Coronary Artery Disease in Women Having Cardiac Catheterization Disturbed stress responses in women with polycystic ovary syndrome Effects of bariatric surgery on mortality in Swedish obese subjects. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Menstrual cycle irregularity and risk for future cardiovascular disease. Simvastatin improves biochemical parameters in women with polycystic ovary syndrome: results of a prospective, randomized trial. Metformin administration improves endothelial function in women with polycystic ovary syndrome. Metformin reduces serum C-reactive protein levels in women with polycystic ovary syndrome. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. The effect of atorvastatin in patients with polycystic ovary syndrome: a randomized double-blind placebo-controlled study. Body fat distribution and 5-year risk of death in older women. Comparison of simvastatin and metformin in treatment of polycystic ovary syndrome: prospective randomized trial. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Increased risk of non-insulin dependent diabetes mellitus, arterial hypertension and coronary artery disease in perimenopausal women with a history of the polycystic ovary syndrome. Effects of exercise on lipoprotein particles in women with polycystic ovary syndrome. Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome. Atherogenic forms of dyslipidaemia in women with polycystic ovary syndrome. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Effects of metformin and ethinyl estradiol-cyproterone acetate on lipid levels in obese and non-obese women with polycystic ovary syndrome. Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. Metformin reduces arterial stiffness and improves endothelial function in young women with polycystic ovary syndrome: a randomized, placebo-controlled, crossover trial. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome.
BACKGROUND Dyslipidemia is common in women with polycystic ovary syndrome ( PCOS ) but its prevalence in different PCOS phenotypes is still largely unknown . METHODS We measured  plasma lipids and lipoproteins  in 35 anovulatory PCOS ( age : 25 + /- 6 years , BMI : 28 + /- 6 kg/m(2 ) ) , 15 ovulatory PCOS ( age : 30 + /- 6 years , BMI : 25 + /- 3 kg/m(2 ) ) and 27 healthy women ( controls ) age- and BMI -matched with ovulatory PCOS . PCOS was diagnosed by the presence of clinical or biologic hyper and rogenism associated with chronic anovulation and /or polycystic ovaries at ultrasound . In women with normal menses chronic anovulation was indicated by low serum progesterone levels ( < 9.54 nmol/l ) during midluteal phase ( days 21 - 24 ) in two consecutive menstrual cycles . RESULTS Total cholesterol , triglycerides and low-density lipoprotein (LDL)-cholesterol levels increased and high-density lipoprotein (HDL)-cholesterol decreased from controls to ovulatory and then to anovulatory PCOS ( all P < 0.05 ) . Levels of lipoprotein(a ) ( Lp(a ) ) and small , dense LDL increased ( P < 0.0001 for both ) and LDL size reduced ( P < 0.005 ) between groups . Insulin resistance ( by HOMA ) showed a positive correlation with triglycerides and small , dense LDL and an inverse correlation with HDL-cholesterol and LDL size ( P < 0.05 for all ) in both PCOS phenotypes . No significant correlations were found with testosterone levels . At multivariate analysis , insulin resistance was independently associated with HDL-cholesterol and small , dense LDL in both PCOS phenotypes and with triglyceride concentrations in ovulatory PCOS only . CONCLUSIONS Women with ovulatory PCOS showed milder forms of atherogenic dyslipidemia than anovulatory PCOS and this seemed to be related to the extent of insulin resistance . Future prospect i ve studies are needed to assess the relative contribution of such alterations on cardiovascular risk We prospect ively estimated the prevalence of the polycystic ovary syndrome ( PCOS ) , as defined by the NIH/NICHHD 1990 endocrine criteria , in a population of 154 Caucasian women of reproductive age reporting spontaneously for blood donation .  Anthropometric data ; the presence of hirsutism , acne , and and rogenic alopecia ; and the menstrual history were recorded by a single investigator . In 145 women , blood sample s were also obtained for measurement of serum and rogen levels .  PCOS was defined by the presence of 1 ) oligomenorrhea , 2 ) clinical and /or biochemical hyper and rogenism , and 3 ) exclusion of hyperprolactinemia , thyroid disorders , and nonclassic 21-hydroxylase deficiency . Hirsutism was defined by a modified Ferriman-Gallwey score of 8 or more , acne was considered as a sign of hyper and rogenism when persistent after the second decade of life , and hyper and rogenemia was defined by an increase in circulating testosterone or dehydroepi and rosterone sulfate or an increase in the free and rogen index above the 95th percentile of the control values derived from the nonhirsute , nonacneic women having regular menses who were not receiving hormonal therapy . PCOS was present in 10(6.5 % ) , hirsutism was present in 11 ( 7.1 % ) , and acne was present in 19 ( 12.3 % ) of the 154 women . Our results demonstrate a 6.5 % prevalence of PCOS , as defined , in a minimally biased population of Caucasian women from Spain . The polycystic ovary syndrome , hirsutism , and acne are common endocrine disorders in women We performed this study to access the changes in glucose tolerance over time in a group of women with polycystic ovary syndrome ( PCOS ) ( n = 71 ) and control women ( n = 23 ) with regular menstrual cycles and baseline normal glucose tolerance . Mean follow-up was between 2 and 3 yr for both groups ( PCOS 2.5 + /- 1.7 yr ; controls 2.9 + /- 2.1 yr ) . Based on World Health Organization glucose tolerance categories , there was no significant difference in the prevalence of glucose intolerance at follow-up in the PCOS group . In the PCOS group , 25 ( 37 % ) had impaired glucose tolerance ( IGT ) and seven ( 10 % ) had type 2 diabetes mellitus at baseline , compared with 30 ( 45 % ) and 10 ( 15 % ) , respectively , at follow-up . There were also no differences within groups ( PCOS or control ) or between groups ( PCOS vs. control ) in the oral glucose tolerance test-derived measure of insulin sensitivity , but in the women with PCOS who converted to either IGT or type 2 diabetes mellitus , there was a significant decrease ( P < 0.0001 ) . At the follow-up visit , the mean glycohemoglobin level was 6.1 + /- 0.9 % in women with PCOS vs. 5.3 + /- 0.7 % in the control women ( P < 0.001 ) . Women with PCOS and baseline IGT had a low conversion risk of 6 % to type 2 diabetes over approximately 3 yr , or 2 % per year . The effect of PCOS , given normal glucose tolerance ( NGT ) at baseline , is more pronounced with 16 % conversion to IGT per year . Our study supports that women with PCOS ( especially with NGT ) should be periodically rescreened for diabetes due to worsening glucose intolerance over time , but this interval may be over several years and not annually BACKGROUND Cross-sectional studies have shown a high frequency of impaired glucose tolerance ( IGT ) and non-insulin dependent diabetes mellitus ( NIDDM ) in women with polycystic ovarian syndrome ( PCOS ) . However , little is known about the change in glucose tolerance that occurs over a period of several years in women with PCOS . METHODS Sixty-seven women with PCOS received a 75 g glucose tolerance test and measurement of lipids at baseline and at follow-up after an average time of 6.2 years . All women followed prospect ively had normal glucose tolerance ( n = 54 ) or IGT ( n = 13 ) at the start of the study . RESULTS Change in glycaemic control from baseline was frequent , with 5/54 ( 9 % ) of normoglycaemic women at baseline developing IGT and a further 4/54 ( 8 % ) moving directly from normoglycaemic to NIDDM . For women with IGT at baseline , 7/13 ( 54 % ) had NIDDM at follow-up . Body mass index ( BMI ) at baseline was an independent significant predictor of adverse change in glycaemic control . CONCLUSIONS Women with PCOS , particularly those with a high BMI , should be review ed regularly with respect to IGT or NIDDM , as the frequency of impaired glycaemic control is high , and that the rate of conversion from normal glucose tolerance to IGT or NIDDM , or from IGT to NIDDM is substantial CONTEXT Polycystic ovary syndrome ( PCOS ) presents in adolescence , and obesity is a common finding . The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear . OBJECTIVE We investigated the effects of metformin , oral contraceptives ( OCs ) , and /or lifestyle modification in obese adolescent women with PCOS . DESIGN Two small , r and omized , placebo-controlled clinical trials were performed . PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated . INTERVENTIONS In the single treatment trial , subjects were r and omized to metformin , placebo , a lifestyle modification program , or OC . In the combined treatment trial , all subjects received lifestyle modification and OC and were r and omized to metformin or placebo . MAIN OUTCOME MEASURES Serum concentrations of and rogens and lipids were measured . RESULTS Lifestyle modification alone result ed in a 59 % reduction in free and rogen index with a 122 % increase in SHBG . OC result ed in a significant decrease in total testosterone ( 44 % ) and free and rogen index ( 86 % ) but also result ed in an increase in C-reactive protein ( 39.7 % ) and cholesterol ( 14 % ) . The combination of lifestyle modification , OC , and metformin result ed in a 55 % decrease in total testosterone , as compared to 33 % with combined treatment and placebo , a 4 % reduction in waist circumference , and a significant increase in HDL ( 46 % ) . CONCLUSIONS In these preliminary trials , both lifestyle modification and OCs significantly reduce and rogens and increase SHBG in obese adolescents with PCOS . Metformin , in combination with lifestyle modification and OC , reduces central adiposity , reduces total testosterone , and increases HDL , but does not enhance overall weight reduction BACKGROUND Our aim was to assess the effects of metformin on menstrual frequency , fasting plasma glucose ( FPG ) , insulin resistance assessed as HOMA-index , weight , waist/hip ratio , blood pressure ( BP ) , serum lipids , and testosterone levels in women with polycystic ovary syndrome ( PCOS ) METHODS : In a r and omized , controlled , double-blinded setup , 56 women aged 18 - 45 with PCOS were treated with either metformin 850 mg or placebo twice daily for 6 months . After a wash-out period of 3 months participants received the alternate treatment for 6 months . The changes in the measured parameters were analysed by intention-to-treat and per protocol . RESULTS There were no changes in menstrual frequency . In the intention-to-treat analysis , weight and systolic BP were reduced on metformin treatment ( p=0.009 and 0.047 , respectively ) , while high-density lipoprotein ( HDL ) increased ( p=0.001 ) . On placebo , weight and FPG increased ( p<0.05 ) . Post-hoc subgrouping according to BMI revealed reductions in testosterone ( p=0.013 ) , FPG ( p=0.018 ) , insulin ( p=0.045 ) and HOMA-index ( p=0.022 ) in obese women . Per protocol analysis showed the following differences between the changes on placebo and metformin ( mean ( 5 - 95 % percentiles ) : weight ( -4.2 ( -7.0 , -1.9 ) kg , p<0.001 ) , FPG ( -0.23 ( -0.44 , -0.01 ) mmol/l , p=0.041 ) , insulin ( -4.17 ( -8.10 , -0.23 ) mIU/l , p=0.039 ) and HOMA index ( -1.50 ( -2.53 , -0.47 ) mIU/l*mmol/l , p=0.006 ) . Weight , FPG and HOMA index were lower after metformin than after placebo . CONCLUSIONS Metformin treatment lowered weight and systolic blood pressure and increased HDL in women with PCOS . In post-hoc analysis it increased insulin sensitivity and lowered testosterone in obese women . Non-obese women did not benefit from metformin PURPOSE Polycystic ovary syndrome ( PCOS ) is an extremely prevalent disorder in which elevated blood markers of cardiovascular risk and altered endothelial function have been found . This study was design ed to determine if abnormal carotid intima-media thickness ( IMT ) and brachial flow-mediated dilation ( FMD ) in young women with PCOS may be explained by insulin resistance and elevated adipocytokines . METHODS A prospect i ve study in 50 young women with PCOS ( age : 25.2 + /- 1 years ; body mass index [ BMI ] : 28.7 + /- 0.8 ) and 50 matched ovulatory controls ( age : 25.1 + /- 0.7 years ; BMI : 28.5 + /- 0.5 ) was performed . Carotid IMT , brachial FMD , and blood for fasting glucose , insulin , leptin , adiponectin and resistin  were measured . RESULTS PCOS , IMT was increased ( P < .01 ) , FMD was decreased ( P < .01 ) , fasting insulin was increased ( P < .01 ) , QUICKI ( a marker of insulin resistance ) was decreased ( P < .01 ) , and adiponectin was lower ( P < .05 ) , whereas leptin and resistin were not different compared with matched controls . Whereas BMI or waist/hip ratios did not correlate with IMT or FMD , insulin and QUICKI correlated positively and negatively with IMT ( P < .01 ) . There was a significant negative correlation between adiponectin and IMT ( P < .05 ) . These correlations were unchanged when adjusting for BMI and the correlation between IMT and adiponectin was unaffected by insulin resistance parameters . CONCLUSIONS These data suggest that young women with PCOS have evidence for altered endothelial function . Adverse endothelial parameters were correlated with insulin resistance and lower adiponectin . Both insulin resistance and adiponectin appear to be important parameters . It is hypothesized that the type of fat distribution may influence these factors This pilot study assessed the effects of exercise and nutritional counseling on hormonal , menstrual , and reproductive function in women with polycystic ovary syndrome ( PCOS ) . Twelve females with a clinical , biochemical , and ultrasonographic diagnosis of PCOS were r and omly assigned to endurance and resistance exercise plus nutritional counseling ( EN ) or nutritional counseling only ( N ) for a period of 12 weeks . Anthropometry , resting metabolic rate ( RMR ) , selected hormones , and ovarian follicle population were measured pre and post-intervention . Following the 12 week intervention , greater decreases in sum of 2 skinfolds ( p = 0.002 ) and a greater increase in estimated VO2 max ( p = 0.017 ) occurred in the exercise group . Significant decreases in waist girth ( p = 0.001 ) and insulin levels ( p = 0.03 ) occurred in both groups . Hormonal changes were not statistically significant ; however , a trend towards an improved hormonal profile , specifically sex-hormone binding globulin ( EN , 39 % increase ; N , 8 % increase ) and lutenizing hormone : follicle-stimulating hormone ( LH : FSH ) ( EN , 9 % decrease ; N , 27 % decrease ) occurred in the absence of weight loss . These findings suggest exercise and nutritional counseling may benefit the metabolic and reproductive abnormalities associated with PCOS CONTEXT The polycystic ovary syndrome ( PCOS ) is frequently associated with obesity . However , there are very few data about PCOS in morbid obesity , especially with regard to its evolution after bariatric surgery . OBJECTIVE The objective of this study was to evaluate the response of PCOS to the sustained and marked weight loss achieved by  bariatric surgery in morbidly obese women . DESIGN This was a longitudinal prospect i ve nonr and omized evaluation . SETTING S The study was performed at an academic hospital . PATIENTS Thirty-six consecutive premenopausal women su bmi tted to bariatric surgery were screened for PCOS , which was present in 17 . INTERVENTIONS Bariatric surgery was performed . MAIN OUTCOME MEASURES Hyper and rogenism , menstrual function , and insulin resistance were estimated before and at least 6 months after bariatric surgery in 12 patients with PCOS . RESULTS Weight loss ( 41 + /- 9 kg after 12 + /- 5 months ) was paralleled by decreases in the hirsutism score ( from 9.5 + /- 6.8 to 4.9 + /- 4.2 ; P = 0.001 ) , total ( 69 + /- 32 to 42 + /- 19 ng/dl ; P < 0.02 ) and free testosterone ( from 1.6 + /- 0.7 to 0.6 + /- 0.3 ng/dl ; P < 0.005 ) , and rostenedione ( from 4.1 + /- 1.5 to 3.0 + /- 0.9 ng/ml ; P < 0.02 ) , and dehydroepi and rosterone sulfate ( from 2000 + /- 1125 to 1353 + /- 759 ng/ml ; P < 0.005 ) ; amelioration of insulin resistance estimated by homeostasis model assessment ( from 6.0 + /- 3.0 to 1.6 + /- 1.0 ; P < 0.001 ) ; and restoration of regular menstrual cycles and /or ovulation in all patients . CONCLUSIONS The PCOS is a frequent finding in women with morbid obesity and may resolve after weight loss induced by bariatric surgery Women with polycystic ovary syndrome ( PCOS ) often develop type 2 diabetes mellitus ( T2DM ) . To determine the magnitude of risk of developing T2DM among women with PCOS , development of T2DM was prospect ively assessed among women who had T2DM ( n = 97 ) and controls ( n = 95 ) using Kaplan-Meier survival analysis and Cox proportional hazards modeling . The women with T2DM had higher baseline weight ( body mass index , P < 0.01 ) and lower insulin sensitivity ( homeostasis assessment model of insulin resistance , P < 0.01 ) . The 8-year incidence rate among cases and controls was 13.4 % and 5.8 % , respectively ( relative risk = 2.3 ) . Obese cases had a fivefold risk of T2DM developing ( P < 0.01 ) compared with age-adjusted obese controls , indicating significant interaction between PCOS and obesity to effect T2DM risk OBJECTIVE To examine the efficacy of sibutramine together with brief lifestyle modification for weight reduction in obese women with polycystic ovary syndrome ( PCOS ) . DESIGN Investigator-initiated , multicenter , double-blind , r and omized , parallel-group clinical trial . SETTING Departments of Obstetrics and Gynecology in primary care , referral centers , and private practice . PATIENT(S ) Forty-two patients with confirmed PCOS were included in the study , and 34 patients completed the study . INTERVENTION Sibutramine 15 mg once daily together with brief lifestyle modification was compare with placebo together with brief lifestyle modification . MAIN OUTCOME MEASURE(S ) The primary endpoint was to assess weight loss . Secondary endpoints included the efficacy of sibutramine for treatment of menstrual pattern and cardiovascular risk factors . RESULT ( S ) After 6 months the sibutramine group had lost 7.8 + /- 5.1 kg compared with a weight loss of 2.8 + /- 6.2 kg in the placebo group . Sibutramine treatment result ed in significant decreases in apolipoprotein B , apolipoprotein B/apolipoprotein A ratio , triglycerides , and cystatin C levels . CONCLUSION ( S ) Sibutramine in combination with lifestyle intervention results in significant weight reduction in obese patients with PCOS . In addition to the weight loss , sibutramine seems to have beneficial effects on metabolic and cardiovascular risk factors Coronary artery disease is the most common cause of death among women in developed countries . Established risk factors for coronary disease in women include smoking [ 1 ] , high serum cholesterol levels [ 2 ] , low high-density lipoprotein ( HDL ) cholesterol levels [ 3 ] , diabetes , and hypertension [ 2 ] . Premenopausal women have a lower risk for heart disease than do postmenopausal women [ 4 ] . Polycystic ovaries are seen in 22 % of women [ 5 , 6 ] and are associated with hirsutism , infertility , and menstrual disturbances [ 7 ] . Insulin resistance [ 8 ] , higher serum triglyceride levels , and lower HDL cholesterol levels [ 9 ] commonly occur in women with polycystic ovaries ; these factors may be associated with a higher incidence of coronary artery disease [ 10 , 11 ] . The metabolic syndrome of hypertension , diabetes , and central obesity ( the Stein-Leventhal syndrome ) is also associated with polycystic ovaries [ 12 ] . We sought to determine whether women with more extensive coronary artery disease ( as seen on coronary angiography ) are more likely to have polycystic ovaries appearing on ultrasonography than are women with less extensive coronary disease . Methods All women 60 years of age or younger who had had coronary angiography in Auckl and , New Zeal and , in the preceding 2 years were invited to participate in this study . Women who had had bilateral oophorectomy were excluded . The local ethics committee approved the study . Women who were menstruating were studied between days 5 and 9 of the menstrual cycle . Data were collected on infertility ( failure to conceive within 1 year ) , menstrual cycle irregularity ( > a 4-day variation ) , hypercholesterolemia ( requiring medication ) , hypertension ( requiring medication ) , and a family history of heart disease in a first-degree female relative younger than 60 years of age or in a first-degree male relative younger than 55 years of age . Hirsutism was assessed on the Ferriman-Gallwey scale [ 13 ] .  Ultrasonography  was done prospect ively , without knowledge of the coronary angiography results . In consenting patients ( 71.3 % ) , a transvaginal ultrasound was also done . Polycystic ovaries were defined by modified Adams criteria [ 14 ] as eight or more cysts that were between 2 and 8 mm in diameter and were associated with an increase in ovarian stroma . Chest pain ( 96 % of women ) or valvular disease ( 4 % of women ) was assessed by angiography after administration of nitroglycerin spray . Quantitative angiography was done using a computerized automatic analysis system ( Cardiovascular Measurement Systems , Neunen , the Netherl and s ) . The extent of coronary artery disease was evaluated by adding the number of segments containing stenoses of more than 50 % diameter according to the Coronary Artery Surgery Study scoring system [ 15 ] . A secondary end point was severity of coronary artery disease . Patients were given a score on the basis of luminal diameter narrowing according to the following scale : 25 % luminal diameter narrowing , 1 point ; 26 % to 50 % , 2 points ; 51 % to 75 % , 4 points ; 76 % to 90 % , 8 points ; 91 % to 99 % , 16 points ; and 100 % , 32 points . Each stenosis was multiplied by the appropriate score . Functional significance was evaluated by the Coronary Artery Surgery Study [ 15 ] weighting system , which accounts for the severity and location of stenoses . Continuous variables were analyzed using one-way analysis of variance . Discrete variables were analyzed using chi-square tests . Multiple logistic regression analysis was done using the presence or absence of polycystic ovaries as the outcome variable . Explanatory variables include those listed in Table 1 and Table 2 and the extent of coronary artery disease . Explanatory variables were entered into the model in a stepwise fashion if they had a P value of 0.15 . These variables included age , extent of coronary artery disease , total cholesterol level , HDL cholesterol level , presence of diabetes , family history of heart disease , and history of smoking . Table 1 . Characteristics of Women with Normal Ovaries and Women with Polycystic Ovaries * Table 2 . Laboratory Findings in Women with Normal Ovaries and Women with Polycystic Ovaries * Results Of 207 women , 143 ( 69 % ) agreed to participate . One or more ovaries were visualized in 99.3 % of the study women either by transabdominal ( 77.6 % ) or transvaginal ( 94 % ) ultrasonography . Neither ovary was visualized in one woman , and her results were excluded . Clinical characteristics are shown in Table 1 . Polycystic ovaries were diagnosed by ultrasonography in 42.3 % of women . There was no difference in the prevalence of polycystic ovaries between premenopausal women and postmenopausal women ( 25 of 48 women and 35 of 94 women , respectively ; P = 0.13 ) . The differences in ovaries seen by ultrasonography were present in both premenopausal ( follicle-stimulating hormone level < 20 IU/L ) and postmenopausal ( follicle-stimulating hormone level > 20 IU/L ) women [ 16 ] . One woman had previously received a diagnosis of the polycystic ovary ( Stein-Leventhal ) syndrome . Compared with women with normal ovaries , women with polycystic ovaries had higher triglyceride levels ( P < 0.01 ) and lower HDL cholesterol levels ( P < 0.05 ) , although more women with polycystic ovaries were receiving lipid-lowering medications ( P = 0.01 ) . Compared with women who had normal ovaries , women with polycystic ovaries had higher free testosterone levels ( P < 0.001 ) and a trend for increased C-peptide levels ( P = 0.06 ) ( Table 2 ) . These differences all persisted when the data were stratified according to whether the women were premenopausal or postmenopausal [ 16 ] . Women with polycystic ovaries had more coronary artery segments with greater than 50 % diameter loss ( 1.7 segments [ 95 % CI , 1.1 to 2.3 segments ] ) than did women with normal ovaries ( 0.82 segments [ CI , 0.54 to 1.1 segments ] ) ( P < 0.01 ) . Women with polycystic ovaries had a higher functional significance score ( 1767 [ CI , 1123 to 2412 ] ) than did women with normal ovaries ( 1029 [ CI , 709 to 1349 ] ) ( P = 0.05 ) and had a trend toward a higher severity score ( 39.5 [ CI , 29.3 to 49.7 ] and 28.7 [ CI , 22.2 to 35.2 ] , respectively ; P = 0.06 ) . Forty-nine women with normal ovaries ( 59.8 % ) and 32 women with polycystic ovaries ( 53.3 % ) did not have coronary artery stenoses of 50 % or more ( P > 0.2 ) . By multivariate logistic regression analysis , the extent of coronary artery disease was found to be independently associated with the presence of polycystic ovaries ( P = 0.032 ) , as was family history of heart disease ( P = 0.022 ) . If the extent score increased by 1 , the odds ratio increased by approximately 26 % . Discussion Our study has three important findings . First , in women having coronary angiography , those with more extensive coronary artery disease were more likely to have polycystic ovaries appearing on sonography than were women with less extensive coronary disease . Second , polycystic ovaries were identified in postmenopausal women . Third , the diagnosis of polycystic ovaries seen on ultrasonography was associated with specific metabolic and endocrine abnormalities . Women with polycystic ovaries have been shown to have risk factors for coronary disease [ 8 - 11 ] . However , a direct association between polycystic ovaries and angiographic coronary artery disease has not been previously reported . Diagnosis of polycystic ovaries in postmenopausal women by ultrasonography  has only recently been described [ 16 ] . Our finding of a high incidence of polycystic ovaries relates to the patients studied , all of whom had had coronary angiography . The women with polycystic ovaries had high testosterone and triglyceride levels , low HDL cholesterol levels , and some insulin resistance . Women with polycystic ovaries seen on ultrasonography  often do not have the clinical features of the polycystic ovarian syndrome . The disorder probably exists on a continuum ranging from no symptoms to the fully developed syndrome . Why should polycystic ovaries appear on ultrasonography more frequently in women with more extensive coronary artery disease than in women with less extensive disease ? Polycystic ovaries are the most common cause of anovulation with reduced production of estradiol . Decreased estradiol levels may be associated with coronary artery disease , shown by the reduced incidence of heart disease in postmenopausal women receiving estrogen replacement therapy [ 17 ] . Although estrone levels are elevated in women with polycystic ovaries , estrone is less potent than estradiol and may not be cardioprotective . Insulin resistance could be the link between polycystic ovaries and coronary artery disease . We found that C-peptide levels , a stable indicator of insulin production , were higher in women with polycystic ovaries than in women with normal ovaries . Abnormal lipid levels may also account for the increase in significant coronary artery disease . In addition , women with increased testosterone production may have a risk for adverse cardiac events similar to that of men .  Hirsutism  has also been reported as a risk factor for coronary artery disease in women [ 18 ] . What are the implication s of our findings ? Young women with polycystic ovaries often present with hirsutism , acne , infertility , or menstrual irregularity . Once the diagnosis of polycystic ovaries has been made , lifestyle modifications may be indicated to decrease cardiovascular risk . Further research must be done to investigate the natural history and to determine whether any of the current treatments for polycystic ovaries , such as the oral contraceptive pill , anti and rogens , ovulatory agents , or laparoscopic ovarian surgery , are beneficial . From National Women 's Hospital , University of Auckl and , and Green Lane Hospital , Auckl and , New Zeal and . Dr. Farquhar : National Women 's Hospital , Epsom , Auckl and 1003 , New Zeal and . Dr. White : Cardiology Department , Green Lane Hospital , Epsom , Auckl and 1003 , New Zeal and BACKGROUND We analyzed the neuroendocrine and immune cell responses to psychosocial stress in PCOS patients compared to BMI -matched healthy controls . METHODS Responses to public speaking stress were analyzed in 32 PCOS patients and 32 BMI -matched healthy controls . At baseline , during , and 10- and 45-min after stress , state anxiety , cardiovascular responses , cortisol , ACTH , as well as circulating leukocyte sub population s were analyzed , together with hsCRP and serum IL-6 concentrations . RESULTS In response to public speaking stress , both groups showed significant but comparable increases in state anxiety , and blood pressure ( all p<0.001 ; time effects ) . The ACTH and cortisol stress responses were significantly enhanced in PCOS ( both p<0.05 ; interaction effect ) . In addition , heart rate was significantly higher in PCOS ( p<0.05 ; group effect ) . PCOS patients displayed a reduced upregulation of IL-6 levels in response to stress ( p<0.05 ; interaction effect ) . Baseline levels of circulating leukocyte sub population s , IL-6 and hsCRP concentrations did not differ between BMI -matched controls and PCOS patients . PCOS patients were characterized by markedly increased psychological distress . CONCLUSIONS PCOS patients showed enhanced HPA-axis and heart rate reactivity as well as a reduced upregulation of IL-6 in response to stress . The altered stress reactivity in PCOS patients may constitute a link between depression , overweight , and the cardiovascular and diabetes risks associated with the diagnosis BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects Cross-sectional studies suggest that women who have irregular menstrual cycles and hyper and rogenism may be at increased risk for cardiovascular disease ( CVD ) . However , prospect i ve data are lacking on the relationship between menstrual cycle irregularity and subsequent CVD risk . The objective of this study was to assess prospect ively the risk for coronary heart disease ( CHD )  and stroke associated with a history of irregular menstrual cycles . The study design was a prospect i ve cohort study of 82,439 female nurses who provided information in 1982 on prior menstrual regularity ( at ages 20 - 35 yr ) and were followed through 1996 for cardiovascular events . Incident reports of nonfatal myocardial infa rct ion , fatal CHD , and nonfatal and fatal stroke were made . Medical records were review ed for confirmation . During 14 yr ( 1,155,915 person-yr ) of follow-up , there were 1417 incident cases of CHD and 838 incident cases of stroke , including 471 cases of ischemic stroke . Compared with women reporting a history of very regular menstrual cycles , women reporting usually irregular or very irregular cycles had an increased risk for nonfatal or fatal CHD [ age-adjusted relative risks ( RR ) , 1.25 and 1.67 , respectively ; 95 % confidence intervals ( CI ) , 1.07 - 1.47 and 1.35 - 2.06 , respectively ] . Increased risks for CHD associated with prior cycle irregularity remained significant after adjustment for body mass index and several potential confounders . There was a nonsignificant increase in overall stroke risk ( RR , 1.30 ; 95 % CI = 0.97 - 1.74 ) and in ischemic stroke risk ( RR , 1.40 ; 95 % CI = 0.97 - 2.04 ) associated with very irregular cycles . Menstrual cycle irregularity may be a marker of metabolic abnormalities predisposing to increased risk for CVD OBJECTIVE To test the hypothesis that statins improve hyper and rogenemia in women with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve , r and omized trial . SETTING Academic medical center . PATIENT(S ) Forty-eight women with PCOS . INTERVENTION(S ) Subjects were r and omized to a statin group ( simvastatin , 20 mg daily plus oral contraceptive pill [ OCP ] ; n = 24 ) or an OCP group ( OCP alone ; n = 24 ) . MAIN OUTCOME MEASURE(S ) Serum T. RESULT ( S ) Baseline parameters of both groups were comparable . After 12 weeks of treatment , serum T levels declined by 41 % in the statin group and by 14 % in the OCP group . In the statin group , there was a greater decrease of LH ( 43 % decrease vs. 9 % in the OCP group ) and a greater decline of LH/FSH ratio ( 44 % vs. 12 % ) . In the statin group , total cholesterol declined by 10 % and low-density lipoprotein ( LDL ) by 24 % . In the OCP group , total cholesterol increased by 8 % , and LDL was unchanged . CONCLUSION ( S ) This is the first study demonstrating that statin decreases T levels and normalizes gonadotropin levels in women with PCOS . Statin therapy might offer a novel approach , providing endocrine and cardiovascular benefits OBJECTIVE The aim of this study was to investigate the endothelial status in young women with polycystic ovary syndrome ( PCOS ) , using a simple and easily reproducible hemodynamic method combined with a biological marker and to evaluate the effect of metformin treatment on these parameters . DESIGN Descriptive clinical trial . METHODS Forty young women , 20 with PCOS and 20 normal women of similar age and body mass index were studied .  Metformin ( 1700 mg daily ) was administered for 6 months to the PCOS group . The endothelium status and the metabolic and hormonal profile were studied in both groups , as well as after metformin , by flow-mediated dilatation ( FMD ) on the brachial artery and by measurements of plasma endothelin-1 ( ET-1 ) levels . RESULTS FMD was impaired in the PCOS group when compared with controls ( 3.24+/-0.71 % vs 8.81+/-1.07 % respectively , P<0.0001 ) , but this difference normalized after metformin treatment ( PCOS(post-metformin ) vs controls : 8.17+/-1.26 vs 8.81+/-1.07 % , P = 0.70 ) since the values significantly improved after metformin treatment ( PCOS(pre-metformin ) vs PCOS(post-metformin ) : 3.24+/-0.71 vs 8.17+/-1.26 % , P=0.003 ) . ET-1 levels were significantly higher in the PCOS women compared with the control group ( 7.23+/-0.50 vs 4.99+/-0.69 fmol/l , P=0.01 ) , they improved significantly after metformin treatment ( PCOS(pre-metformin ) vs PCOS(post-metformin ) : 7.23+/-0.50 vs 3.57+/-0.60 fmol/l , P<0.0001 ) and their difference compared with the control group was reversed ( PCOS(post-metformin ) vs controls : 3.57+/-0.60 vs 4.99+/-0.69 fmol/l , P=0.13 ) . Metformin administration improved hyper and rogenemia . However , in this study , mathematical methods used to assess insulin resistance failed to show any detected alteration after treatment with metformin . CONCLUSIONS PCOS women were found to exhibit endothelial dysfunction compared with controls , which was reversed 6 months after metformin administration Low- grade chronic inflammation , reflected in elevated levels of serum C-reactive protein ( CRP ) , has recently been linked to obesity , insulin resistance syndromes such as polycystic ovary syndrome ( PCOS ) , and an increased risk of cardiovascular disease . Because the insulin sensitizer metformin has been shown to improve metabolic disturbances in PCOS , it was of particular interest to examine serum CRP levels during metformin therapy .  Twenty nonobese women [ body mass index ( BMI ) < /= 25 kg/m(2 ) ] and 32 obese women ( BMI > /== " BORDER="0 " > 27 kg/m(2 ) ) with PCOS were r and omized to receive either metformin ( 500 mg twice daily for 3 months , then 1000 mg twice daily for 3 months ) or ethinyl estradiol ( 35 micro g)-cyproterone acetate ( 2 mg ) oral contraceptive pills . The serum concentrations of CRP were significantly higher in obese than in nonobese subjects at baseline [ 4.08 + /- 0.53 ( SE ) vs. 1.31 + /- 0.28 mg/liter ; P < 0.001 ] and correlated to BMI and to a lesser extent waist-hip ratio , suggesting that the elevated CRP levels may be related to obesity and not only to PCOS itself . During metformin treatment , serum CRP levels decreased significantly from 3.08 + /- 0.7 mg/liter to 1.52 + /- 0.26 mg/liter at 6 months in the whole study population ( P = 0.006 ) and especially in obese subjects . In contrast , the treatment with ethinyl estradiol-cyproterone acetate increased serum CRP levels from 2.91 + /- 0.68 mg/liter to 4.58 + /- 0.84 mg/liter ( P < 0.001 ) . Whether this effect is related to estrogen action in the liver or whether it reflects increased inflammation process and possible risks for cardiovascular disease remains unclear . The decrease of serum CRP levels during metformin therapy is in accordance with the known beneficial metabolic effects of this drug and suggests that CRP or other inflammation parameters could be used as markers of treatment efficiency in women with PCOS OBJECTIVE To determine the prevalence of insulin resistance ( IR ) in a large population of patients with the polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve , case-control . SETTING University medical center . PATIENT(S ) Two hundred seventy-one PCOS patients and 260 eumenorrheic , non-hirsute , control women . INTERVENTION(S ) History and physical examination and blood sampling . MAIN OUTCOME MEASURE(S ) Total T , free T , DHEAS , sex hormone-binding globulin , and fasting glucose and insulin levels ; homeostatic model assessment values for IR ( HOMA-IR ) and percent beta-cell function ( HOMA-%beta-cell ) . RESULT ( S ) Patients with PCOS and controls differed significantly in all parameters studied , except fasting glucose . Because the HOMA-IR and HOMA-%beta-cell values were variably associated with race , age , and body mass index , the HOMA-IR and HOMA-%beta-cell values were then adjusted for these cofounders . After adjustment , 64.4 % of PCOS patients were noted to be insulin resistant , and 2.6 % had beta-cell dysfunction . Compared with PCOS patients without IR ( n = 96 ) , patients with IR ( n = 174 ) were more obese and had higher beta-cell function . CONCLUSION ( S ) In patients with PCOS , the prevalence of IR was 64 % according to the HOMA-IR measurement , after adjustment . Patients with IR were more clinical ly affected . Although IR is a common abnormality in PCOS , it does not seem to be a universal feature CONTEXT Polycystic ovary syndrome ( PCOS ) is associated with increased risk of cardiovascular morbidity , whereas statins are proven to reduce cardiovascular mortality and morbidity through lipid-lowering and perhaps through their pleiotropic effects . Statins can also reduce testosterone in vitro by inhibiting ovarian theca-interstitial cell proliferation and steroidogenesis and reducing inflammation in vivo . OBJECTIVE Our objective was to assess the effect of atorvastatin on inflammatory markers , insulin resistance , and biochemical hyper and rogenemia in patients with PCOS . DESIGN AND SETTING We conducted a r and omized , double-blind , placebo-controlled study at a tertiary care setting in United Kingdom . PATIENTS Patients included 40 medication-naive patients with PCOS and biochemical hyper and rogenemia . METHODS Patients were r and omized to either atorvastatin 20 mg daily or placebo . MAIN OUTCOME MEASURES The primary endpoint of the study was a change in the inflammatory marker high-sensitivity C-reactive protein . The secondary endpoints were a change in insulin resistance and total testosterone . RESULTS After 12 wk atorvastatin , there was a significant reduction ( mean + /- sem ) in total cholesterol ( 4.6 + /- 0.2 vs. 3.4 + /- 0.2 mmol/liter , P < 0.01 ) , low-density lipoprotein cholesterol ( 2.9 + /- 0.2 vs. 1.8 + /- 0.2 mmol/liter , P < 0.01 ) , triglycerides ( 1.34 + /- 0.08 vs. 1.08 + /- 0.13 mmol/liter , P < 0.01 ) , high-sensitivity C-reactive protein ( 4.9 + /- 1.4 vs. 3.4 + /- 1.1 mg/liter , P = 0.04 ) , free and rogen index ( 13.4 + /- 0.6 vs. 8.7 + /- 0.4 , P < 0.01 ) , testosterone ( 4.1 + /- 0.2 vs. 2.9 + /- 0.1 nmol/liter , P < 0.01 ) and insulin resistance as measured by homeostasis model assessment for insulin resistance ( HOMA-IR ) ( 3.3 + /- 0.4 vs. 2.7 + /- 0.4 ) . There was a significant increase in SHBG ( 31.1 + /- 1.0 vs. 35.3 + /- 1.2 nmol/liter , P < 0.01 ) . There was a positive correlation between the reduction in HOMA-IR in the atorvastatin group with the reduction in triglycerides and the reduction of free and rogen index . There was a significant deterioration of HOMA-IR in the placebo group ( 3.0 + /- 0.4 vs. 3.8 + /- 0.5 ) . CONCLUSIONS This study suggests that atorvastatin is effective in reducing inflammation , biochemical hyper and rogenemia , and metabolic parameters in patients with PCOS after a 12-wk period OBJECTIVE To test the hypothesis that both body mass index ( expressed as the ratio of weight in kilograms per height in meters squared ) and the ratio of waist circumference to hip circumference are positively associated with mortality risk in older women . DESIGN Prospect i ve cohort study with a 5-year follow-up period . SETTING General community . PARTICIPANTS R and om sample of 41,837 Iowa women aged 55 to 69 years . MAIN OUTCOME MEASURE Total mortality ( 1504 deaths ) . MAIN RESULTS Body mass index , an index of relative weight , was associated with mortality in a J-shaped fashion : rates were elevated in the leanest as well as in the most obese women . In contrast , waist/hip circumference ratio was strongly and positively associated with mortality in a dose-response manner . Adjusted for age , body mass index , smoking , education level , marital status , estrogen use , and alcohol use , a 0.15-unit increase in waist/hip circumference ratio ( eg , a 15-cm [ 6-in ] increase in waist measurement in a woman with 100-cm [ 40-in ] hips ) was associated with a 60 % greater relative risk of death . The observed associations were not explained to any great degree by bias from weight loss prior to baseline or higher early deaths among lean participants . CONCLUSIONS Waist/hip circumference ratio is a better marker than body mass index of risk of death in older women . Waist/hip circumference ratio should be measured as part of routine surveillance and risk monitoring in medical practice CONTEXT Polycystic ovary syndrome ( PCOS ) is characterized by ovarian dysfunction and hyper and rogenism ; it is also associated with increased cardiovascular risks such as adverse lipid profile and endothelial dysfunction . Metformin and , more recently , statins have been shown to improve endocrine and metabolic aspects of PCOS . OBJECTIVE The aim of the study was to compare effects of simvastatin and metformin on PCOS . DESIGN In a prospect i ve trial , women with PCOS ( n = 136 ) were r and omized to simvastatin ( S ) , metformin ( M ) , or simvastatin plus metformin ( SM ) groups . Evaluations were performed at baseline and after 3 months . SETTING The study was conducted at an academic medical center . PRIMARY OUTCOME The change of serum total testosterone was measured . RESULTS The study was completed by 113 subjects .  Total testosterone decreased significantly and comparably in all groups : by 17.1 , 13.6 , and 15.1 % , respectively , in the S , M , and SM groups . Significant decreases were also observed in all groups with respect to body mass index , C-reactive protein , and soluble vascular cell adhesion molecule-1 . DHEAS declined significantly only in the S group . None of the treatments were associated with significant changes in LH or FSH . Total cholesterol and low-density lipoprotein cholesterol significantly declined only in S and SM groups . CONCLUSIONS Simvastatin treatment was superior to metformin alone , whereas a combination of simvastatin and metformin was not significantly superior to simvastatin alone BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline The aim of the study was to determine the prevalence of non-insulin dependent diabetes mellitus ( NIDDM ) , arterial hypertension , coronary artery disease and the risk factors for these diseases in perimenopausal women with a history of polycystic ovary syndrome ( PCOS ) treatment . A group of 28 women was selected from a large group of patients who had undergone wedge ovarian resection .  A total of 752 controls was selected by age ( 45 - 59 years ) from a r and om female population sample . There was no difference between the two groups in body mass index , waist circumference or waist-hip ratio . Both groups were found to have identical family histories of NIDDM , hypertension , and coronary artery disease and identical smoking habits . We did not find a difference between the mean concentrations of lipids and fasting glucose . The two groups did not differ in the proportions of women with elevated lipid concentrations . The prevalence of NIDDM and coronary artery disease was significantly higher in PCOS women . In conclusion , women in the general population have the same level of risk factors at perimenopausal age as PCOS women . Patients with markedly expressed clinical symptoms of PCOS made up a subgroup in the general population at high risk for developing NIDDM and coronary artery disease PURPOSE Women with polycystic ovary syndrome ( PCOS ) commonly have insulin resistance . Insulin resistance is associated with marked abnormalities of lipoprotein size and subclass particle concentration . The purpose of this study was to examine the effects of a moderate-intensity exercise program without weight loss on lipoprotein profiles in women with PCOS . METHODS Thirty-seven sedentary PCOS women were r and omized to either an 8- to 12-wk ramp-up followed by a 12-wk moderate-intensity exercise program ( 16 - 24 wk total , approximately 228 min x wk at 40 - 60 % peak V x O2 , n = 21 ) or control ( no change in lifestyle , n = 16 ) . PCOS was defined as < or=8 menses per year and hyper and rogenism ( biochemical or clinical with Ferriman-Gallwey score > or=8 ) . Fasting lipoprotein profiles were obtained before and after the intervention . Nuclear magnetic resonance spectroscopy was used to quantify the following : average particle size , total and subclass concentrations of HDL , LDL , and VLDL particles , and calculated HDL cholesterol , triglycerides , and VLDL triglycerides . Wilcoxon exact rank sums tests were used to compare changes in these parameters in the exercise group relative to controls . RESULTS Twenty women ( 8 exercisers , 12 controls ) completed the study . Comparing exercisers to controls , significant changes were seen in concentrations of the following lipoprotein parameters that are associated with decreased insulin resistance : decreased large VLDL ( P = 0.007 ) , calculated triglycerides ( P = 0.003 ) , VLDL triglycerides ( P = 0.003 ) , and medium/small HDL ( P = 0.031 ) and increased large HDL ( P = 0.002 ) and average HDL size ( P = 0.001 ) . CONCLUSIONS In this trial , moderate-intensity exercise without significant weight loss improved several components of the lipoprotein profiles of women with PCOS . These findings support the beneficial role of moderate exercise in this high-risk population CONTEXT Polycystic ovary syndrome ( PCOS ) is an endocrine disease closely related to several risk factors for cardiovascular disease . An impaired cardiopulmonary functional capacity was previously demonstrated in PCOS women . No data regarding the effects of a structured exercise training ( ET ) program on cardiopulmonary functional capacity in PCOS women are available . OBJECTIVE Our objective was to evaluate the effects of a 3-month ET program on cardiopulmonary functional capacity in young PCOS women . DESIGN AND SETTING A prospect i ve baseline-r and omized clinical study was conducted at the University " Federico II " of Naples , School of Medicine ( Italy ) . PATIENTS Ninety young overweight PCOS women were enrolled . MEAN OUTCOME MEASURES Ninety young PCOS women were r and omly subdivided into two groups , each composed of 45 subjects . The PCOS-T ( trained ) group underwent a 3-month structured ET program , whereas the PCOS-UnT ( untrained ) group did not . Hormonal and metabolic profiles and cardiopulmonary and exercise parameters were evaluated . RESULTS After 3-month ET , PCOS-T showed a significant improvement in peak oxygen consumption ( + 35.4 % ; P<0.001 ) and in maximal workload ( + 37.2 % ; P<0.001 ) . In PCOS-T we also observed a significant reduction in body mass index ( -4.5 % ; P<0.001 ) and in C-reactive protein ( -10 % ; P<0.001 ) , and a significant ( P<0.001 ) improvement in insulin sensitivity indexes . After 3 months , no changes were observed in PCOS-UnT. CONCLUSIONS A 3-month structured ET program improves cardiopulmonary functional capacity in young PCOS women OBJECTIVE Dyslipidaemia is very common in patients with polycystic ovary syndrome ( PCOS ) but , beyond plasma lipids , atherogenic lipoprotein ( Lp ) and apolipoprotein ( apo ) alterations are still ill defined . DESIGN We measured concentrations of apoB , Lp(a ) and small , dense low-density lipoprotein ( LDL )  in 42 patients with PCOS [ age : 28 + /- 7 years , body mass index ( BMI ): 27 + /- 5 kg/m(2 ) ] vs. 37 age- and BMI -matched healthy controls . METHODS Elevated  Lp(a ) levels  considered were those > 30 mg/dl while elevated apoB concentrations were those > 100 g/l . RESULTS Polycystic ovary syndrome showed increased triglycerides levels ( p = 0.0011 ) and lower high-density lipoprotein (HDL)-cholesterol concentrations ( p = 0.0131 ) while total- and LDL cholesterol were similar . PCOS also showed smaller LDL size ( p = 0.0005 ) , higher levels of total small , dense LDL ( p < 0.0001 ) , higher concentrations of Lp(a ) , as considered as absolute values ( p = 0.0143 ) and log-transformed ( p = 0.0014 ) , while no differences were found in apoB levels . Elevated Lp(a ) concentrations were found in 24 % of PCOS , while elevated apoB levels were relatively uncommon ( 14 % ) . Spearman correlation analysis revealed that Lp(a ) concentrations were weakly correlated only with HDL-cholesterol levels ( r = -0.378 , p = 0.0431 ) . In addition , 36 % of patients with PCOS with normal plasma lipid profile showed elevated levels of Lp(a ) , apoB or small , dense LDL . CONCLUSIONS Atherogenic Lp abnormalities may be found in one-third of women with PCOS who have a normal lipid pattern . Future prospect i ve studies are needed to test to which extent such atherogenic forms of dyslipidaemia may contribute to the increased cardiovascular risk in young women with PCOS BACKGROUND Surprisingly , the prevalence of polycystic ovary syndrome ( PCOS ) in otherwise unselected overweight or obese women is unknown , despite obesity being frequent in patients with PCOS . We conducted the present study to obtain an unbiased estimate of the prevalence of PCOS in unselected overweight and obese premenopausal women from Spain . METHODS All premenopausal women reporting to the Department of Endocrinology , Hospital Universitario Ramón y Cajal , for dietary treatment of overweight or obesity from May 2002 to December 2005 were prospect ively recruited . Women referred for any other reason were automatically excluded to avoid selection bias . Diagnosis of PCOS relied on the presence of clinical and /or biochemical hyper and rogenism , oligo-ovulation , and exclusion of secondary causes . Anthropometric measurements , hirsutism scores , and and rogen , gonadotropin , metabolic , and lipid profiles were obtained . RESULTS Of a total of 113 consecutive women recruited , 32 ( 28.3 % ) were diagnosed as having PCOS ( 95 % confidence interval , 20.0%-36.6 % ) . The prevalence of PCOS was not different when considering the degree of obesity . Another 3 women presented with hyper and rogenemia without oligo-ovulation , 2 had idiopathic hirsutism , 2 had chronic oligomenorrhea without clinical or biochemical hyper and rogenism , and 2 had oligomenorrhea with hyperprolactinemia , precluding the diagnosis of PCOS . The remaining 72 women ( 63.7 % ) had no evidence of hyper and rogenism or reproductive abnormalities . CONCLUSIONS Our results demonstrate a 28.3 % prevalence of PCOS in overweight and obese women from Spain , which is markedly increased compared with the 5.5 % prevalence of PCOS in lean women of our country . Therefore , PCOS must be routinely ruled out in overweight and obese premenopausal women seeking advice for weight loss Women with polycystic ovary syndrome ( PCOS ) are insulin resistant , have insulin secretory defects , and are at high risk for glucose intolerance . We performed this study to determine the prevalence of glucose intolerance and parameters associated with risk for this in PCOS women . Two-hundred and fifty-four PCOS women , aged 14 - 44 yr , were prospect ively evaluated at 2 centers , 1 urban and ethnically diverse ( n = 110 ) and 1 rural and ethnically homogeneous ( n = 144 ) . The rural PCOS women were compared to 80 control women of similar weight , ethnicity , and age . A 75-g oral glucose challenge was administered after a 3-day 300-g carbohydrate diet and an overnight fast with 0 and 2 h blood sample s for glucose levels .  Diabetes was categorized according to WHO criteria . The prevalence of glucose intolerance was 31.1 % impaired glucose intolerance ( IGT ) and 7.5 % diabetes . In nonobese PCOS women ( body mass index , < 27 kg/m2 ) , 10.3 % IGT and 1.5 % diabetes were found . The prevalence of glucose intolerance was significantly higher in PCOS vs. control women ( chi2 = 7.0 ; P = 0.01 ; odds ratio = 2.76 ; 95 % confidence interval = 1.23 - 6.57 ) . Variables most associated with postchallenge glucose levels were fasting glucose levels ( P < 0.0001 ) , PCOS status ( P = 0.002 ) , waist/hip ratio ( P = 0.01 ) , and body mass index ( P = 0.021 ) . The American Diabetes Association criteria applied to fasting glucose significantly underdiagnosed diabetes compared to the WHO criteria ( 3.2 % vs. 7.5 % ; chi2 = 4.7 ; P = 0.046 ; odds ratio = 2.48 ; 95 % confidence interval = 1.01 - 6.69 ) . We conclude that 1 ) PCOS women are at significantly increased risk for IGT and type 2 diabetes mellitus at all weights and at a young age ; 2 ) these prevalence rates are similar in 2 different population s of PCOS women , suggesting that PCOS may be a more important risk factor than ethnicity or race for glucose intolerance in young women ; and 3 ) the American Diabetes Association diabetes diagnostic criteria failed to detect a significant number of PCOS women with diabetes by postchallenge glucose values Despite considerable clinical interest , attempts to link perceived self-efficacy with successful weight control have had mixed success . Definitive data on prospect i ve associations between self-efficacy and weight loss are particularly sparse . This study examined relationships between self-efficacy beliefs , weight control behaviors , and weight change among individuals participating in a weight loss trial ( N = 349 , 87 % women ) . Cross-sectionally , eating and exercise self-efficacy beliefs were strongly associated with corresponding weight loss behaviors . Self-efficacy beliefs prospect ively predicted weight control behavior and weight change during active treatment but not during follow-up . Mediational models indicate that people 's weight control behaviors mediate the impact of self-efficacy on weight change OBJECTIVE Women with polycystic ovary syndrome ( PCOS ) exhibit risk factors for cardiovascular diseases such as abdominal obesity , insulin resistance and dyslipidemia . Insulin sensitizers , especially metformin , have been shown to improve these metabolic disturbances , but there are only a few studies on their effects on serum lipids in polycystic ovary syndrome . METHODS Thirty-five women with PCOS ( 18 obese and 17 non-obese ) were r and omized to 6-month treatments with metformin or ethinyl estradiol-cyproterone acetate oral contraceptive pills . RESULTS In the whole- study population ( non-obese and obese women ) serum levels of high-density lipoprotein cholesterol increased from 1.4+/-0.2 to 1.6+/-0.1 mmol/l ( means + /-S.E. throughout ) at 3 and 6 months ( P < 0.001 ) , the total cholesterol : high-density lipoprotein cholesterol ratio decreased significantly from 3.8+/-0.3 to 3.3+/-0.2 at 6 months ( P < 0.001 ) and a similar trend was observed in serum triglyceride levels during metformin treatment . In the oral contraceptive group , serum levels of total cholesterol increased from 4.9+/-0.3 to 5.4+/-0.3 mmol/l ( P < 0.05 ) , high-density lipoprotein cholesterol increased from 1.2+/-0.1 to 1.5+/-0.1 mmol/l ( P < 0.001 ) , the total cholesterol : high-density lipoprotein cholesterol ratio decreased from 4.6+/-0.4 to 3.7+/-0.2 ( P < 0.001 ) and triglycerides increased from 1.3+/-0.1 to 1.9+/-0.2 mmol/l at 6 months of treatment ( P < 0.001 ) . Serum low-density lipoprotein cholesterol levels remained unchanged during both treatments . Milder but similar changes in the subgroups of obese and non-obese women were observed during both treatments . Moreover , in the whole- study population both systolic ( P = 0.02 ) and diastolic ( P = 0.05 ) blood pressures decreased over the 6 months of metformin treatment . CONCLUSION In women with PCOS , metformin treatment had beneficial effects on lipid profile and blood pressure , and therefore it could be useful in the prevention of cardiovascular complications in these women OBJECTIVE To determine the prevalence of insulin resistance ( IR ) in women with polycystic ovary syndrome ( PCOS ) using baseline fasting blood measurements of glucose and insulin . DESIGN Prospect i ve clinical study . SETTING Academic endocrinology unit in Palermo , Italy . PATIENT(S ) Two hundred and sixty-seven women with PCOS , consecutively evaluated , and 50 consecutively selected ovulating controls . INTERVENTION(S ) Fasting blood was obtained for glucose and insulin measurements from all women . For 60 women with PCOS and 20 controls an insulin tolerance test ( ITT ) was also performed . MAIN OUTCOME MEASURE(S ) Assessment of normal and abnormal values for fasting insulin , glucose/insulin ratio , and the calculated indices of the homeostasis model assessment ( HOMA ) , quantitative sensitivity check index ( QUICKI ) , as well as Kitt ( kinetic disappearance of glucose ) values after ITT . Evaluation was performed of the ability to detect IR using these methods in obese and nonobese women with PCOS . RESULT ( S ) Normal insulin sensitivity was defined by insulin levels < 12 mU/mL , glucose/insulin ratios of > 6.4 , HOMA values of < 47 , and QUICKI values of > 0.333 . In the entire PCOS groups , IR was diagnosed in 65.4 % of women using glucose/insulin ratios and in 77 % and 79.2 % using HOMA and QUICKI . In obese women ( body mass index > 28 in 48 % of group ) , IR was present in 76.7 % as measured by glucose/insulin ratios but was significantly higher ( 95.3 % ) using values of either HOMA or QUICKI ( P<.01 ) . All indices correlated with Kitt values with QUICKI showing the best correlation . CONCLUSION ( S ) Insulin resistance was detected in approximately 80 % of women with PCOS , and in 95 % of obese women . The detection of IR is superior using the calculated indices HOMA and QUICKI CONTEXT Patients with polycystic ovary syndrome ( PCOS ) have an increased prevalence of insulin resistance and display sub clinical evidence of early cardiovascular disease . Metformin improves insulin sensitivity and circulating markers of cardiovascular risk in patients with PCOS , but it is unclear whether this translates into improvements in vascular function . OBJECTIVE Our objective was to evaluate the effects of metformin on arterial stiffness and endothelial function in women with PCOS . DESIGN AND INTERVENTION Thirty women with PCOS were assigned to consecutive 12-wk treatment periods of metformin or placebo in a r and omized , double-blind , crossover design separated by an 8-wk washout . MAIN OUTCOME MEASURES The primary outcome measures were assessment s of arterial stiffness [ augmentation index ( AIx ) , central blood pressure , and brachial and aortic pulse wave velocity ( PWV ) ] and endothelial function . Anthropometry , testosterone , and metabolic biochemistry ( lipids , homeostasis model of assessment for insulin resistance , high-sensitivity C-reactive protein , adiponectin , and plasminogen activator inhibitor-1 ) were also assessed . RESULTS Metformin improved AIx [ -6.1 % ; 95 % confidence interval ( CI ) for the difference -8.5 to -3.5 % ; P < 0.001 ] , aortic PWV ( -0.76 m/sec ; 95 % CI for the difference -1.12 to -0.4 m/sec ; P < 0.001 ) , brachial PWV ( -0.73 m/sec ; 95 % CI for the difference -1.09 to -0.38 ; P < 0.001 ) , central blood pressure ( P < 0.001 ) , and endothelium-dependent ( AIx after albuterol ; P = 0.003 ) and endothelium-independent ( AIx after nitroglycerin ; P < 0.001 ) vascular responses . Metformin also reduced weight ( P < 0.001 ) , waist circumference ( P < 0.001 ) , and triglycerides ( P = 0.004 ) and increased adiponectin ( P = 0.001 ) but did not affect testosterone or other metabolic measures . CONCLUSIONS Short-term metformin therapy improves arterial stiffness and endothelial function in young women with PCOS OBJECTIVE To assess the impact of adding exercise to dietary restriction on depressive symptoms and health-related quality of life ( HRQOL ) in women with polycystic ovary syndrome ( PCOS ) . DESIGN Analysis of depression and quality of life outcomes from a r and omized , controlled prospect i ve clinical intervention that evaluated the effects on a range of health outcomes in women with PCOS . SETTING Clinical research unit . PATIENT(S ) One hundred four overweight/obese PCOS women ( aged 29.3 ± 0.7 years ; body mass index [ BMI ] 36.1 ± 0.5 kg/m(2 ) ) . INTERVENTION(S ) R and omized to one of three 20-week lifestyle programs : diet only , diet and aerobic exercise , or diet and combined aerobic-resistance exercise . MAIN OUTCOME MEASURE(S ) Depression and PCOS-specific HRQOL . RESULT ( S ) Forty-nine women completed the intervention ( diet only = 14 , diet and aerobic exercise = 15 , diet and combined aerobic-resistance exercise = 20 ) . By week 20 all groups achieved weight loss and had improvements in depression and PCOS-specific HRQOL scores , except for body hair domain score . There was no difference between treatments for all outcomes . CONCLUSION ( S ) This study demonstrated that dietary restriction alone and combined with exercise had similar benefits for improving depression and HRQOL scores in overweight and obese women with PCOS
OBJECTIVE Women with polycystic ovary syndrome ( PCOS ) often have cardiovascular disease ( CVD ) risk factors .
The And rogen Excess and Polycystic Ovary Syndrome ( AE-PCOS ) Society created a panel to provide evidence -based review s of studies assessing PCOS-CVD risk relationships and to develop guidelines for preventing CVD .