Smaller LDL particle size in women with polycystic ovary syndrome comparedto controls

OBJECTIVE Women with polycystic ovary syndrome (PCOS) have an increased ris k of cardiovascular disease, The contribution of lipid abnormalities to thi s higher risk, in particular atherogenic modifications of tory density lipo protein (LDL) such as a shift towards smaller IDL, has not been properly ex plored. We aimed to examine LDL size variation in relation to androgens and other risk factors in women with PCOS. DESIGN Comparison of clinical and biochemical measurements in women with PC OS and women with normal ovarian function, of similar age and body mass ind ex (BMI). PATIENTS Thirty-one women with PCOS and 27 controls were studied. Patients were recruited from the outpatient endocrine clinic. MEASUREMENTS Pasting total cholesterol, triglycerides (TG), high density li poprotein (HDL), LDL, glucose, insulin, gonadotrophins, androgens, oestradi ol: II OH progesterone and SHBG were measured, LDL particle diameter was ca lculated based on distance travelled in polyacrylamide native gels. Recumbe nt blood pressure was measured automatically. RESULTS LDL particle size appeared to be significantly smaller in hyperandr ogenic PCOS as compared to regularly cycling women (P = 0006), independent of variations in lipid levels, SHBG was the only independent predictor of L DL size In this population, with a strong correlation, which persisted afte r adjustment for all confounding variables. CONCLUSIONS Our results suggest that androgen excess and mild insulin-resis tance (both responsible for lower SHBG) may have an early modifying effect on low density lipoprotein size in polycystic ovary syndrome women. The den ser pattern observed in polycystic ovary syndrome women could by itself con stitute a higher cardiovascular risk, even in the absence of overt dyslipid aemia, and contribute to the excess risk of cardiovascular disease reported in this syndrome.