DYSLIPIDEMIA IN POLYCYSTIC OVARIAN SYNDROME - DIFFERENT GROUPS, DIFFERENT ETIOLOGIES

The objective was to study the pathophysiology of the dyslipidaemia in polycystic ovarian syndrome (PCOS) patients, and to determine how it is related to hyperinsulinaemia, hyperandrogenism and dehydroepiandros terone sulphate (DHEA-S) concentrations. The lipoprotein lipid profile , anthropometric measurements, endocrine profile and the presence of i nsulin resistance were evaluated in 31 PCOS patients and 20 age-matche d healthy women, who served as controls, PCOS patients had higher fast ing insulin concentrations, higher body mass indexes (BMI) and were hy perlipidaemic, with higher. total cholesterol, low density lipoprotein (LDL) and triglyceride (TG) concentrations. There were no relationshi ps between plasma lipids and anthropometric variables in the patient g roup as a whole, Insulin-resistant (IR) and non-IR (NIR) PCOS patients were then evaluated separately. Obesity with marked hyperandrogenism were the predominant features in patients with IR, NIR patients were n ot obese and had significantly less hyperandrogenism. The adrenal andr ogen DHEA-S was at the upper limit of its normal range in both groups, However, both PCOS subgroups exhibited similar significant abnormalit ies in terms of their lipid parameters, Insulin and DHEA-S concentrati ons were positively correlated with total cholesterol, LDL and TG, and negatively correlated with high density lipoprotein, in IR patients, In NIR subjects, insulin was not correlated with any of the lipids and DHEA-S was negatively related to cholesterol and LDL, Anthropometric variables were related to lipids in only the NIR patients, Thus PCOS s ubjects as a group exhibit dyslipidaemia, characterized by increased t otal cholesterol, LDL and TG concentrations. When divided into IR and NIR subjects, there were no differences in the degree of lipid abnorma lities, despite significant variations fin the BMI and androgen status , Thus, in PCOS subjects, dyslipidaemia may occur irrespective of insu lin resistance, Insulin and DHEA-S concentrations were positively corr elated with an atherogenic lipid profile in the IR group only. As dist inct from syndrome X when IR was present, dyslipidaemia was not relate d to body weight or the waist:hip ratio, In the NIR group there was no relationship between lipids and insulin; DHEA-S, on the other hand, w as negatively related to cholesterol and LDL concentrations. Thus, dys lipidaemia in PCOS patients may occur irrespective of insulin resistan ce, and mag have different metabolic aetiologies depending on DHEA-S m etabolism, It remains to be seen whether the two types of PCOS are ass ociated with different risks for ischaemic heart disease.