DYSLIPIDEMIA IS ASSOCIATED WITH INSULIN-RESISTANCE IN WOMEN WITH POLYCYSTIC OVARIES

OBJECTIVE Polycystic ovary syndrome (PCOS) is characterized by hyperin sulinaemia and insulin resistance. Previous reports of lipid abnormali ties in the syndrome have produced conflicting results which may, in p art, be related to the lack of appropriate controls for the obese wome n with PCOS. Only one study has related lipid levels to insulin sensit ivity. The objective of this study was to assess lipids and lipoprotei ns in women with PCOS, to compare the results with weight matched cont rols, and to relate the findings to indices of insulin secretion and a ction, and to menstrual history. DESIGN A cross-sectional study of ins ulin sensitivity and lipids in a cohort of PCO subjects compared to we ight and ethnic group matched controls. PATIENTS AND METHODS We have t herefore investigated glucose tolerance, plasma lipids and lipoprotein s In 19 lean (LP) and 55 obese (OF) patients with PCO and compared the results with those in 22 lean (LC) and 15 obese (OC) control women. I nsulin sensitivity was measured in the same subjects with a short insu lin (0.05 U/kg i.v. insulin) tolerance test (LP, n = 18; OP, n = 20; L C, n = 19; OC, n = 11). RESULTS Results are expressed as mean+/-SEM or median (interquartile range). Pasting plasma glucose levels were simi lar in the four groups but the plasma glucose area was higher after or al glucose (75 g) in both the lean and obese PCOS groups than in their controls (LC 32.4 +/- 0.7 vs LP 35.2 +/- 1.2, P < 0.01; OC 34.7 +/- 1 .8 vs OP 37.8 +/- 1.5 mmol/l/3 h, P < 0.01). Insulin sensitivity was s ignificantly reduced in obese PCOS women (LC 196 +/- 9 vs LP 179 +/- 9 , NS; OC 168 +/- 12 vs OP 133 +/- 9 mmol/l/min, P < 0.01). Total serum cholesterol levels were similar in the lour groups but HDL(2)-cholest erol was reduced in both obese and lean PCOS (LC 0.42 (0.38-0.62), LP 0.31 (0.26-0.44), P < 0.05; OC 0.34 (0.21-0.47), OP 0.21 (0.12-0.32)mm ol/l, P < 0.01). Total HDL-cholesterol was decreased significantly onl y in the obese PCOS group. Body mass index correlated significantly an d negatively with total HDL-cholesterol and with HDL-cholesterol level s both within the PCOS group and the control women. Using multiple reg ression insulin insensitivity contributes significantly beyond BMI to the low HDL-cholesterol in women with polycystic ovaries. CONCLUSION P olycystic ovary syndrome is associated with biochemical risk factors f or premature vascular disease, which cannot be explained by obesity al one.