Obstet Gynecol Sci.  2013 May;56(3):137-142.

Dyslipidemia in women with polycystic ovary syndrome

• Kim JJ
• Choi YM

Abstract

Dyslipidemia is a very common metabolic abnormality in women with polycystic ovary syndrome (PCOS). Insulin resistance is a key pathophysiology of PCOS, thus dyslipidemia in women with PCOS may be consistent with those found in an insulin resistant state. In recent meta-analysis, triglycerides and low-density lipoprotein (LDL) cholesterol levels were 26 mg/dL and 12 mg/dL higher, and high-density lipoprotein cholesterol concentration was 6 mg/dL lower in women with PCOS than those of controls. Alterations in LDL quality also have been reported in women with PCOS: women with PCOS have an increased proportion of atherogenic small dense LDL or decreased mean LDL particle size. However, in a recent Korean study, non-obese Korean women with PCOS had no significant quantitative or qualitative changes in LDL cholesterol profile. Lipoprotein (a) has been identified as an independent risk factor for coronary heart disease, and its elevation in PCOS patients has been consistently reported in diverse studies including non-obese Korean population. Some studies have investigated apolipoprotein (Apo) A-I and ApoC-I levels in women with PCOS and levels of ApoA-I, which has cardio-protective effects, were significantly lower in women with PCOS than those of controls. ApoC-I is known to increase the postprandial serum lipid level that is common in coronary artery disease patients, and one study reported that such an elevation may be the earliest variation of lipid abnormality in women with PCOS. In conclusion, women with PCOS should receive a complete lipid test, and lifestyle modification, including diet and exercise, is the first line therapy for all women with PCOS and is particularly important for those with dyslipidemia.

Keyword

Dyslipidemia; Insulin resistance; Metabolic syndrome; Polycystic ovary syndrome

MeSH Terms

Apolipoprotein A-I
Apolipoproteins
Cholesterol
Cholesterol, LDL
Coronary Artery Disease
Coronary Disease
Diet
Dyslipidemias
Female
Humans
Insulin
Insulin Resistance
Life Style
Lipoprotein(a)
Lipoproteins
Particle Size
Polycystic Ovary Syndrome
Risk Factors
Triglycerides
Apolipoprotein A-I
Apolipoproteins
Cholesterol
Cholesterol, LDL
Insulin
Lipoprotein(a)
Lipoproteins
Triglycerides

Reference

1. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998. 83:3078–3082.

2. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000. 85:2434–2438.

3. Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med. 2001. 111:607–613.

4. Sniderman AD, Scantlebury T, Cianflone K. Hypertriglyceridemic hyperapob: the unappreciated atherogenic dyslipoproteinemia in type 2 diabetes mellitus. Ann Intern Med. 2001. 135:447–459.

5. Barter PJ, Brewer HB Jr, Chapman MJ, Hennekens CH, Rader DJ, Tall AR. Cholesteryl ester transfer protein: a novel target for raising HDL and inhibiting atherosclerosis. Arterioscler Thromb Vasc Biol. 2003. 23:160–167.

6. Brunzell JD, Ayyobi AF. Dyslipidemia in the metabolic syndrome and type 2 diabetes mellitus. Am J Med. 2003. 115:Suppl 8A. 24S–28S.

7. Taskinen MR. LDL-cholesterol, HDL-cholesterol or triglycerides: which is the culprit? Diabetes Res Clin Pract. 2003. 61:Suppl 1. S19–S26.

8. Lee H, Oh JY, Sung YA, Chung H, Cho WY. The prevalence and risk factors for glucose intolerance in young Korean women with polycystic ovary syndrome. Endocrine. 2009. 36:326–332.

9. Wild RA, Painter PC, Coulson PB, Carruth KB, Ranney GB. Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1985. 61:946–951.

10. Meirow D, Raz I, Yossepowitch O, Brzezinski A, Rosler A, Schenker JG, et al. Dyslipidaemia in polycystic ovarian syndrome: different groups, different aetiologies? Hum Reprod. 1996. 11:1848–1853.

11. Robinson S, Henderson AD, Gelding SV, Kiddy D, Niththyananthan R, Bush A, et al. Dyslipidaemia is associated with insulin resistance in women with polycystic ovaries. Clin Endocrinol (Oxf). 1996. 44:277–284.

12. Diamanti-Kandarakis E, Mitrakou A, Raptis S, Tolis G, Duleba AJ. The effect of a pure antiandrogen receptor blocker, flutamide, on the lipid profile in the polycystic ovary syndrome. J Clin Endocrinol Metab. 1998. 83:2699–2705.

13. Talbott E, Clerici A, Berga SL, Kuller L, Guzick D, Detre K, et al. Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. J Clin Epidemiol. 1998. 51:415–422.

14. Dejager S, Pichard C, Giral P, Bruckert E, Federspield MC, Beucler I, et al. Smaller LDL particle size in women with polycystic ovary syndrome compared to controls. Clin Endocrinol (Oxf). 2001. 54:455–462.

15. Orio F Jr, Palomba S, Spinelli L, Cascella T, Tauchmanova L, Zullo F, et al. The cardiovascular risk of young women with polycystic ovary syndrome: an observational, analytical, prospective case-control study. J Clin Endocrinol Metab. 2004. 89:3696–3701.

16. Yilmaz M, Biri A, Bukan N, Karakoc A, Sancak B, Toruner F, et al. Levels of lipoprotein and homocysteine in non-obese and obese patients with polycystic ovary syndrome. Gynecol Endocrinol. 2005. 20:258–263.

17. Wild RA, Rizzo M, Clifton S, Carmina E. Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Fertil Steril. 2011. 95:1073–1079.e1-11.

18. Warnick GR, Nauck M, Rifai N. Evolution of methods for measurement of HDL-cholesterol: from ultracentrifugation to homogeneous assays. Clin Chem. 2001. 47:1579–1596.

19. Talbott E, Guzick D, Clerici A, Berga S, Detre K, Weimer K, et al. Coronary heart disease risk factors in women with polycystic ovary syndrome. Arterioscler Thromb Vasc Biol. 1995. 15:821–826.

20. Conway GS, Agrawal R, Betteridge DJ, Jacobs HS. Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992. 37:119–125.

21. Valkenburg O, Steegers-Theunissen RP, Smedts HP, Dallinga-Thie GM, Fauser BC, Westerveld EH, et al. A more atherogenic serum lipoprotein profile is present in women with polycystic ovary syndrome: a case-control study. J Clin Endocrinol Metab. 2008. 93:470–476.

22. Recabarren SE, Smith R, Rios R, Maliqueo M, Echiburu B, Codner E, et al. Metabolic profile in sons of women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2008. 93:1820–1826.

23. Sam S, Legro RS, Essah PA, Apridonidze T, Dunaif A. Evidence for metabolic and reproductive phenotypes in mothers of women with polycystic ovary syndrome. Proc Natl Acad Sci U S A. 2006. 103:7030–7035.

24. Sam S, Legro RS, Bentley-Lewis R, Dunaif A. Dyslipidemia and metabolic syndrome in the sisters of women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005. 90:4797–4802.

25. Legro RS, Blanche P, Krauss RM, Lobo RA. Alterations in low-density lipoprotein and high-density lipoprotein subclasses among Hispanic women with polycystic ovary syndrome: influence of insulin and genetic factors. Fertil Steril. 1999. 72:990–995.

26. Pirwany IR, Fleming R, Greer IA, Packard CJ, Sattar N. Lipids and lipoprotein subfractions in women with PCOS: relationship to metabolic and endocrine parameters. Clin Endocrinol (Oxf). 2001. 54:447–453.

27. Berneis K, Rizzo M, Lazzarini V, Fruzzetti F, Carmina E. Atherogenic lipoprotein phenotype and low-density lipoproteins size and subclasses in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2007. 92:186–189.

28. Doi SA, Abbas JM, Parkinson L, Chakraborty J, Akanji AO. LDL species heterogeneity in the atherogenic dyslipidemia of polycystic ovary syndrome. Am J Clin Pathol. 2008. 129:802–810.

29. Rizzo M, Berneis K, Hersberger M, Pepe I, Di Fede G, Rini GB, et al. Milder forms of atherogenic dyslipidemia in ovulatory versus anovulatory polycystic ovary syndrome phenotype. Hum Reprod. 2009. 24:2286–2292.

30. Phelan N, O'Connor A, Kyaw-Tun T, Correia N, Boran G, Roche HM, et al. Lipoprotein subclass patterns in women with polycystic ovary syndrome (PCOS) compared with equally insulin-resistant women without PCOS. J Clin Endocrinol Metab. 2010. 95:3933–3939.

31. Sidhwani S, Scoccia B, Sunghay S, Stephens-Archer CN, Mazzone T, Sam S. PCOS is associated with atherogenic changes in lipoprotein particle number and size independent of body weight. Clin Endocrinol (Oxf). 2011. 02. 15. [Epub]. http://dx.doi.org/10.1111/j.1365-2265.2011.04015.x.

32. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002. 106:3143–3421.

33. Kim JJ, Chae SJ, Choi YM, Hwang KR, Song SH, Yoon SH, et al. Atherogenic changes in low-density lipoprotein particle profiles were not observed in non-obese women with polycystic ovary syndrome. Hum Reprod. 2013. 28:1354–1360.

34. Groot PH, van Stiphout WA, Krauss XH, Jansen H, van Tol A, van Ramshorst E, et al. Postprandial lipoprotein metabolism in normolipidemic men with and without coronary artery disease. Arterioscler Thromb. 1991. 11:653–662.

35. Phillips NR, Waters D, Havel RJ. Plasma lipoproteins and progression of coronary artery disease evaluated by angiography and clinical events. Circulation. 1993. 88:2762–2770.

36. Huang S, Qiao J, Li R, Wang L, Li M. Can serum apolipoprotein C-I demonstrate metabolic abnormality early in women with polycystic ovary syndrome? Fertil Steril. 2010. 94:205–210.

37. Emerging Risk Factors Collaboration. Erqou S, Kaptoge S, Perry PL, Di Angelantonio E, Thompson A, et al. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 2009. 302:412–423.

38. Erqou S, Thompson A, Di Angelantonio E, Saleheen D, Kaptoge S, Marcovina S, et al. Apolipoprotein(a) isoforms and the risk of vascular disease: systematic review of 40 studies involving 58,000 participants. J Am Coll Cardiol. 2010. 55:2160–2167.

39. Dube JB, Boffa MB, Hegele RA, Koschinsky ML. Lipoprotein(a): more interesting than ever after 50 years. Curr Opin Lipidol. 2012. 23:133–140.

40. Berneis K, Rizzo M, Hersberger M, Rini GB, Di Fede G, Pepe I, et al. Atherogenic forms of dyslipidaemia in women with polycystic ovary syndrome. Int J Clin Pract. 2009. 63:56–62.

41. Chae SJ, Kim JJ, Choi YM, Hwang KR, Jee BC, Ku SY, et al. Clinical and biochemical characteristics of polycystic ovary syndrome in Korean women. Hum Reprod. 2008. 23:1924–1931.

42. Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010. 95:2038–2049.

43. Banaszewska B, Pawelczyk L, Spaczynski RZ, Dziura J, Duleba AJ. Effects of simvastatin and oral contraceptive agent on polycystic ovary syndrome: prospective, randomized, crossover trial. J Clin Endocrinol Metab. 2007. 92:456–461.

44. Sathyapalan T, Kilpatrick ES, Coady AM, Atkin SL. The effect of atorvastatin in patients with polycystic ovary syndrome: a randomized double-blind placebo-controlled study. J Clin Endocrinol Metab. 2009. 94:103–108.