Polikistik Over Sendromlu Kadınlarda Yaşlanma Sürecindeki Metabolik ve Kardiyovasküler Değişimlerin Sağlıklı Kadınlarla Karşılaştırmalı Olarak İncelenmesi

Abstract

Aksun Şahin MS, A Comparative Study of The Metabolic and Cardiovascular Changes Associated With Aging in Women With Polycystic Ovary Syndrome. Hacettepe University, Thesis in Internal Medicine, Ankara, 2023. Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disorder in reproductive aged women, characterized by androgen excess, ovulatory dysfunction and polycystic ovaries. Cardiometabolic risk factors are more common in women with PCOS who have classical phenotypes with oligo-anovulation and hyperandrogenism. However, the clinical and biochemical characteristics of PCOS change with aging. In this study, we aimed to re-evaluate the women in an unselected population who had previously been diagnosed with PCOS or found to be healthy in order to determine the effects of aging on cardiometabolic risk. Forty-one women who were diagnosed with PCOS and phenotyped properly according to the Rotterdam criteria and 43 women of similar age who were found to be healthy in 2009 were included in this study. All participants were evaluated by structured interview, physical examination, anthropometric, hormonal and biochemical measurements. In addition, echocardiographic measurement and body composition analysis of 30 women with PCOS and 30 age-matched healthy women were conducted. According to results of the current study, there was no difference between the patient and the control groups in terms of BMI, waist circumference, hip circumference, waist/hip ratio and blood pressure in 2022. In both groups, testosterone, free androgen index (FAI) and dehydroepiandrostenedione sulphate (DHEAS) values measured in 2022 were significantly lower compared to those values 2009, and in PCOS patients, total testosterone, FAI, DHEAS levels were still higher than controls. Prevalence of metabolic syndrome appeared to be increased by approximately 2-fold in both groups without a significant difference between patients and controls in 2022. Echocardiographic assesment showed similar systolic functions, strain measurements and epicardial fat measurement between patient and control groups. There were also positive correlations between epicardial fat thickness and BMI, waist circumference, waist/hip ratio, increase in waist circumference over the years and HOMA-IR levels. There were positive correlations between epicardial fat thickness and whole body fat percentage and mass, as well truncal fat percentage and mass (r = 0.285, p = 0.03), (r = 0.312, p = 0.02), (r = 0.262, p = 0.04), (r = 0.320, p = 0.01) respectively. Epicardial fat thickness (EFT) measurements showed significant difference among 3 subphenotypes where phenotype C has the highest values (p=0.04). When the whole study group was divided by FAI median values, those with higher FAI showed higher EFT values (p=0.02): There was also a trend for higher EFT in PCOS patients with higher FAI (p=0.09).

Our results suggest higher androgen levels and similar cardiometabolic risk in unselected women with PCOS compared to healthy controls during perimenopausal years. Further research is needed on larger community-based cohorts where older patients are assessed with a longer follow-up.