Effects of Medical Therapy on Insulin Resistance and the Cardiovascular System in Polycystic Ovary Syndrome
| Autor: | Caroline Meyer, Barry P McGrath, Helena J. Teede |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment Models Biological Body Mass Index Cardiovascular Physiological Phenomena Insulin resistance Internal medicine Diabetes mellitus Internal Medicine medicine Homeostasis Humans Insulin Pulse wave velocity Advanced and Specialized Nursing Glucose tolerance test medicine.diagnostic_test business.industry Glucose Tolerance Test Overweight medicine.disease Polycystic ovary Metformin Femoral Artery Endocrinology Area Under Curve Arterial stiffness Female Insulin Resistance business Contraceptives Oral Polycystic Ovary Syndrome medicine.drug |
| Zdroj: | Monash University |
| ISSN: | 1935-5548 0149-5992 |
| DOI: | 10.2337/dc06-0618 |
| Popis: | OBJECTIVE—We aimed to determine the impact of medical therapy for symptom management on insulin resistance, metabolic profiles, and surrogate markers of cardiovascular disease in polycystic ovary syndrome (PCOS), an insulin-resistant pre-diabetes condition. RESEARCH DESIGN AND METHODS—One hundred overweight women (BMI >27 kg/m2), average age 31 years, who were nonsmokers, were not pregnant, did not have diabetes, and were off relevant medications for 3 months completed this 6-month open-label controlled trial. Randomization was to a control group (higher-dose oral contraceptive [OCP] 35 μg ethinyl estradiol [EE]/2 mg cyproterone acetate, metformin [1 g b.d.] or low-dose OCP [20 μg EE/100 μg levonorgestrel + aldactone 50 mg b.d.]). Primary outcome measures were insulin resistance (area under curve on oral glucose tolerance test) and surrogate markers of cardiovascular disease including arterial stiffness (pulse wave velocity [PWV]) and endothelial function. RESULTS—All treatments similarly and significantly improved symptoms including hirsutism and menstrual cycle length. Insulin resistance was improved by metformin and worsened by the high-dose OCP. Arterial stiffness worsened in the higher-dose OCP group (PWV 7.46 vs. 8.03 m/s, P < 0.05), related primarily to the increased insulin resistance. CONCLUSIONS—In overweight women with PCOS, metformin and low- and high-dose OCP preparations have similar efficacy but differential effects on insulin resistance and arterial function. These findings suggest that a low-dose OCP preparation may be preferable if contraception is needed and that metformin should be considered for symptomatic management, particularly in women with additional metabolic and cardiovascular risk factors. |
| Databáze: | OpenAIRE |
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