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Calculated LDL by Age Cases vs. Controls. Figure 1. HDLT by Age Cases vs . Controls. Figure 3. Triglycerides by Age Cases vs. Controls. Figure 5. Insulin by Age Cases vs. Controls. Figure 6. Androstenedione by Age Cases vs. Controls. Figure 7. Clinic BMI by Age Cases vs. Controls.

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study population pcos and the risk of chd part ii l996 99
Study Population:PCOS and the Risk of CHD,Part II (l996-99)
  • 160 PCOS cases and 160 controls 30+ years of age participating in PHASE II (1996-1999) of the Cardiovascular Health and Risk Measurement (CHARM) Study
  • Ongoing protocol to evaluate the CHD risk factors and subclinical atherosclerosis as measured by carotid ultrasound in women with PCOS.
research methodology
Research Methodology
  • Clinic Visit (continued)
    • Blood analyte assessment
      • Lipids ( total cholesterol, triglycerides, LDLc, HDLc)
      • Fasting glucose and insulin
      • Fibrinolytic/coagulation parameters
        • tissue plasminogen activator (tPA)
        • plasminogen activator inhibitor (PAI-1)
carotid atherosclerotic index cai
Carotid Atherosclerotic Index (CAI)
  • Represents the overall mean of the mean measurements of carotid intima-media thickness at 8 sites
  • Arterial sites of interest included :
    • left/ right proximal common carotid
    • left/ right distal common carotid
    • left/ right carotid bulb
    • left/ right distal internal carotid
baseline demographic and reproductive factors in pcos
Baseline Demographic and Reproductive Factors in PCOS

Click for larger picture

Arteriosclerosis, Thrombosis,

and Vascular Biology, 2000;20:2414-2421

baseline cardiovascular risk factors in pcos
BaselineCardiovascularRisk Factors in PCOS

Arteriosclerosis, Thrombosis, and

Vascular Biology, 2000;20:2414-2421

Click for larger picture

plaque indexed was also scored
Plaque Indexed was also scored:

Plaque was defined as a distinct area protruding into the vessel lumen with at least 50% or > thickness than the surrounding area.

Scoring was as follows: 0= no stenosis, 1 = small stenosis <30% of vessel area, 2= 1 medium stenosis between 30-50% of vessel area or multiple small stenoses and 3=1 large stenosis >50% or multiples with at 1 medium stenosis.

These were summed to create an overall plaque index.

plaque index in pcos
Plaque Index in PCOS

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Arteriosclerosis, Thrombosis, and Vascular

Biology, 2000;20:2414-2421

carotid imt in pcos by age and bmi
Carotid IMT in PCOS by Age and BMI

ns ns .219 .040

BMI:

Age:

< 45 years > 45 years

univariate regression of imt and baseline chd risk factors summary
Univariate Regression of IMT and Baseline CHD Risk Factors- summary
  • Risk factors included:
    • PCOS, BMI, hormone use, smoking status, LDL, HDL, DBP, SBP, insulin, W:H, age, total T, and TRIG
  • In the total group and less than 45 years of age, significant risk factors included:
    • BMI, DBP, SBP, insulin, W:H, age, TRIG
  • In women 45 years or greater, significant risk factors included:
    • PCOS, BMI, LDL, SBP, insulin, TRIG

Arteriosclerosis, Thrombosis, and Vascular Biology, 2000;20:2414-2421

regression modeling of imt in pcos women and controls 45 years
Regression Modeling of IMT in PCOS Women and Controls 45 years

Models

1 PCOS

Age

2 PCOS

Age

BMI

3 PCOS

Age

BMI

LDL

Beta

.309

.021

.206

.022

.017

.227

.020

.014

.003

SE

.095

.013

.100

.013

.006

.099

.013

.006

.002

Sig

.002

.107

.042

.092

.008

.024

.124

.030

.048

Arteriosclerosis, Thrombosis, and Vascular Biology, 2000;20:2414-2421

regression modeling of imt in pcos women and controls 45 years cont
Regression Modeling of IMT in PCOS Women and Controls 45 years (cont.)

Models

4 PCOS

Age

BMI

SBP

5 PCOS

Age

BMI

DBP

6 PCOS

Age

BMI

TRIG

Beta

.174

.013

.016

.002

.178

.014

.017

.002

.195

.021

.016

.033

Sig

.088

.322

.037

.535

.085

.287

.024

.699

.068

.113

.030

.716

SE

.101

.013

.007

.004

.102

.013

.007

.006

.105

.013

.007

.090

Arteriosclerosis, Thrombosis, and Vascular Biology, 2000;20:2414-2421

regression modeling of imt in pcos women and controls 45 years cont1
Regression Modeling of IMT in PCOS Women and Controls >45 years (cont.)

Models

7 PCOS

Age

BMI

W:H

8 PCOS

Age

BMI

Insulin

SE

.104

.013

.006

.309

.109

.013

.008

.094

Sig

.112

.314

.007

.883

.256

.094

.034

.471

Beta

.167

.014

.018

.045

.124

.023

.018

.068

Arteriosclerosis, Thrombosis, and Vascular Biology, 2000;20:2414-2421

multivariate regression models of imt effect of pcos
Multivariate Regression Models of IMT- Effect of PCOS
  • Models adjusted for age and BMI
  • Risk factors explored include:
    • PCOS, LDL, SBP, DBP, TRIG, W:H, insulin
  • In the total group PCOS was not a significant predictor of IMT. SBP was only significant independent predictor.
  • In women less than 45 years of age PCOS was not a significant predictor of IMT. SBP and DBP were significant independent predictors.

Arteriosclerosis, Thrombosis, and Vascular Biology, 2000;20:2414-2421

multivariate regression models of imt effect of pcos cont
Multivariate Regression Models of IMT- Effect of PCOS (cont.)
  • In women 45 years or greater PCOS was a significant predictor of IMT, independent of age and BMI (p=.042).
  • With the addition of LDL, this relationship became more significant (p=.024). Both LDL and PCOS exerted independent significant effects.
  • With the addition of SBP, DBP or TRIG, the PCOS-IMT relationship remained borderline significant (p=.068-.088).
  • The addition of insulin or W:H eliminated the significance of PCOS as an independent predictor of IMT.

Arteriosclerosis, Thrombosis, and Vascular Biology, 2000;20:2414-2421

regression summary
Regression Summary:
  • Fasting insulin and W:H appear to attenuate the relationship of PCOS and IMT, suggesting that at least part of the PCOS-IMT association in middle aged PCOS women may be driven by central obesity and hyperinsulinemia.
  • There may be an independent effect of PCOS on IMT mediated by low peak estradiol levels or hormonal dysregulation.
  • An increase in IMT is apparent even in thinner PCOS cases.

Arteriosclerosis, Thrombosis, and Vascular Biology, 2000;20:2414-2421

calcification scores in pcos
Calcification Scores in PCOS

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conclusions
Conclusions:
  • The epidemiologic studies to date have been mainly consistent in their findings of increases in cardiovascular risk factors in women with PCOS. These have however been largely cross-sectional.
  • Subclinical measures have shown increases in women >45 and this would imply a common source long incubation “latency” effect of increases in CHD RF in younger PCOS women over time.
  • However, a prospective study following a larger cohort of women with PCOS is needed to determine if there is a true increased risk of CHD events.