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Das polyzystische Ovarsyndrom als genderspezifischer kardiometabolischer Risikofaktor

Polycystic ovary syndrome as a gender-specific cardiometabolic risk factor

  • Schwerpunkt: Fettstoffwechsel und Metabolisches Syndrom
  • Published:
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Zusammenfassung

Das polyzystische Ovarsyndrom (PCOS) ist mit einer Prävalenz von 15 % die häufigste Endokrinopathie bei Frauen im fertilen Alter. Adipositas und Insulinresistenz spielen eine wesentliche Rolle in der Pathophysiologie des PCOS, modulieren das klinische Beschwerdebild und erhöhen das Risiko der betroffenen Frauen für metabolische Komorbiditäten und Folgen wie Diabetes, nichtalkoholische Fettlebererkrankung sowie kardiovaskuläre Erkrankungen. Das PCOS kann damit als genderabhängiger kardiometabolischer Risikofaktor betrachtet werden. Bei Frauen mit Symptomen, die auf ein PCOS hindeuten, sollte konsequent eine entsprechende Abklärung erfolgen. Bei bekannter PCOS-Diagnose sind über die Behandlung der akuten Beschwerden hinaus ein sorgfältiges Screening auf kardiometabolische Risikofaktoren und Komorbiditäten sowie deren Therapie notwendig. Der Zusammenhang zwischen Insulinresistenz/Adipositas und PCOS kann therapeutisch im individuellen Behandlungskonzept genutzt werden, um sowohl PCOS-spezifische Beschwerden als auch die kardiometabolische Gesundheit zu adressieren.

Abstract

With a prevalence of 15%, polycystic ovary syndrome (PCOS) is the most common endocrinopathy in fertile-aged women. Insulin resistance and obesity play a pivotal role in the pathophysiology of PCOS, modulate the severity of symptoms and are associated with an increased risk for cardiometabolic sequelae such as diabetes, non-alcoholic fatty liver disease and atherosclerotic cardiovascular disease. PCOS should be considered as a gender-specific cardiovascular risk factor. Therefore, if traits indicative for PCOS are present, affected women should undergo PCOS diagnostics as a first step, thereby making it possible to initiate cardiovascular primary prevention strategies in this population of young women at high cardiometabolic risk. In women with known PCOS, screening and treatment of cardiometabolic risk factors and/or diseases should be routinely integrated into the concept of PCOS care. The close link between insulin resistance/obesity and PCOS can be used to improve PCOS-specific symptoms and enhance cardiometabolic health.

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Literatur

  1. Amiri M, Ramezani Tehrani F, Behboudi-Gandevani S, Bidhendi-Yarandi R, Carmina E (2020) Risk of hypertension in women with polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Reprod Biol Endocrinol 18:23

    Article  PubMed  PubMed Central  Google Scholar 

  2. Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Noroozzadeh M, Farahmand M, Rostami Dovom M, Ramezani Tehrani F (2018) The risk of metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 88:169–184

    Article  PubMed  Google Scholar 

  3. Berni TR, Morgan CL, Rees DA (2021) Women with polycystic ovary syndrome have an increased risk of major cardiovascular events: a population study. J Clin Endocrinol Metab 106:e3369–e3380

    Article  PubMed  PubMed Central  Google Scholar 

  4. Brower MA, Hai Y, Jones MR, Guo X, Chen YI, Rotter JI, Krauss RM, Legro RS, Azziz R, Goodarzi MO (2019) Bidirectional Mendelian randomization to explore the causal relationships between body mass index and polycystic ovary syndrome. Hum Reprod 34:127–136

    Article  CAS  PubMed  Google Scholar 

  5. Carmina E, Legro RS, Stamets K, Lowell J, Lobo RA (2003) Difference in body weight between American and Italian women with polycystic ovary syndrome: influence of the diet. Hum Reprod 18:2289–2293

    Article  PubMed  Google Scholar 

  6. Cassar S, Misso ML, Hopkins WG, Shaw CS, Teede HJ, Stepto NK (2016) Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod 31:2619–2631

    Article  CAS  PubMed  Google Scholar 

  7. Escobar-Morreale HF (2018) Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol 14:270–284

    Article  PubMed  Google Scholar 

  8. Falzarano C, Lofton T, Osei-Ntansah A, Oliver T, Southward T, Stewart S, Andrisse S (2022) Nonalcoholic fatty liver disease in women and girls with polycystic ovary syndrome. J Clin Endocrinol Metab 107:258–272

    Article  PubMed  Google Scholar 

  9. Haas CL, Varbo A, Laursen PN, Schnecke V, Balen AH (2023) Association between body mass index, weight loss and the chance of pregnancy in women with polycystic ovary syndrome and overweight or obesity: a retrospective cohort study in the UK. Hum Reprod 38:471–481

    Article  Google Scholar 

  10. Hahn S, Tan S, Elsenbruch S, Quadbeck B, Herrmann BL, Mann K, Janssen OE (2005) Clinical and biochemical characterization of women with polycystic ovary syndrome in North Rhine-Westphalia. Horm Metab Res 37:438–444

    Article  CAS  PubMed  Google Scholar 

  11. Hoeger KM, Dokras A, Piltonen T (2021) Update on PCOS: consequences, challenges, and guiding treatment. J Clin Endocrinol Metab 106:e1071–e1083

    Article  PubMed  Google Scholar 

  12. Javed Z, Papageorgiou M, Deshmukh H, Rigby AS, Qamar U, Abbas J, Khan AY, Kilpatrick ES, Atkin SL, Sathyapalan T (2019) Effects of empagliflozin on metabolic parameters in polycystic ovary syndrome: A randomized controlled study. Clin Endocrinol (Oxf) 90:805–813

    Article  CAS  PubMed  Google Scholar 

  13. Jeffcoate W, Kong MF (2000) Diabete des femmes a barbe: a classic paper reread. Lancet 356:1183–1185

    Article  CAS  PubMed  Google Scholar 

  14. Jensterle M, Herman R, Janez A (2022) Therapeutic potential of glucagon-like peptide‑1 agonists in polycystic ovary syndrome: from current clinical evidence to future perspectives. Biomedicines. https://doi.org/10.3390/biomedicines10081989

  15. Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, Boyle J, Teede HJ (2022) Polycystic ovary syndrome. Lancet Diabetes Endocrinol 10:668–680

    Article  CAS  PubMed  Google Scholar 

  16. Kakoly NS, Earnest A, Teede HJ, Moran LJ, Joham AE (2019) The impact of obesity on the incidence of type 2 diabetes among women with polycystic ovary syndrome. Diabetes Care 42:560–567

    Article  PubMed  Google Scholar 

  17. Kakoly NS, Khomami MB, Joham AE, Cooray SD, Misso ML, Norman RJ, Harrison CL, Ranasinha S, Teede HJ, Moran LJ (2018) Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression. Hum Reprod Update 24:455–467

    Article  CAS  PubMed  Google Scholar 

  18. Kaya MG, Yildirim S, Calapkorur B, Akpek M, Unluhizarci K, Kelestimur F (2015) Metformin improves endothelial function and carotid intima media thickness in patients with PCOS. Gynecol Endocrinol 31:401–405

    Article  CAS  PubMed  Google Scholar 

  19. Kumarendran B, O’Reilly MW, Manolopoulos KN, Toulis KA, Gokhale KM, Sitch AJ, Wijeyaratne CN, Coomarasamy A, Arlt W, Nirantharakumar K (2018) Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: A longitudinal study based on a United Kingdom primary care database. PLoS Med 15:e1002542

    Article  PubMed  PubMed Central  Google Scholar 

  20. Legro RS, Dodson WC, Kris-Etherton PM, Kunselman AR, Stetter CM, Williams NI, Gnatuk CL, Estes SJ, Fleming J, Allison KC, Sarwer DB, Coutifaris C, Dokras A (2015) Randomized controlled trial of preconception interventions in infertile women with polycystic ovary syndrome. J Clin Endocrinol Metab 100:4048–4058

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Lim SS, Kakoly NS, Tan JWJ, Fitzgerald G, Bahri Khomami M, Joham AE, Cooray SD, Misso ML, Norman RJ, Harrison CL, Ranasinha S, Teede HJ, Moran LJ (2019) Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obes Rev 20:339–352

    Article  CAS  PubMed  Google Scholar 

  22. Mills G, Badeghiesh A, Suarthana E, Baghlaf H, Dahan MH (2020) Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies. Hum Reprod 35:1666–1674

    Article  PubMed  Google Scholar 

  23. Moghetti P, Tosi F, Bonin C, Di Sarra D, Fiers T, Kaufman JM, Giagulli VA, Signori C, Zambotti F, Dall’Alda M, Spiazzi G, Zanolin ME, Bonora E (2013) Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab 98:E628–E637

    Article  CAS  PubMed  Google Scholar 

  24. Morley LC, Tang T, Yasmin E, Norman RJ, Balen AH (2017) Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D‑chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev 11:CD3053

    PubMed  Google Scholar 

  25. Poston L, Caleyachetty R, Cnattingius S, Corvalan C, Uauy R, Herring S, Gillman MW (2016) Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol 4:1025–1036

    Article  PubMed  Google Scholar 

  26. Powell-Wiley TM, Poirier P, Burke LE, Despres JP, Gordon-Larsen P, Lavie CJ, Lear SA, Ndumele CE, Neeland IJ, Sanders P, St-Onge MP (2021) Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 143:e984–e1010

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rotterdam EA-SPcwg (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19:41–47

    Article  Google Scholar 

  28. Tan S, Bechmann LP, Benson S, Dietz T, Eichner S, Hahn S, Janssen OE, Lahner H, Gerken G, Mann K, Canbay A (2010) Apoptotic markers indicate nonalcoholic steatohepatitis in polycystic ovary syndrome. J Clin Endocrinol Metab 95:343–348

    Article  CAS  PubMed  Google Scholar 

  29. Tan S, Ignatenko S, Wagner F, Dokras A, Seufert J, Zwanziger D, Dunschen K, Zakaria M, Huseinovic N, Basson CT, Mahling P, Fuhrer D, Hinder M (2021) Licogliflozin versus placebo in women with polycystic ovary syndrome: A randomized, double-blind, phase 2 trial. Diabetes Obes Metab 23:2595–2599

    Article  CAS  PubMed  Google Scholar 

  30. Tan S, Scherag A, Janssen OE, Hahn S, Lahner H, Dietz T, Scherag S, Grallert H, Vogel CI, Kimmig R, Illig T, Mann K, Hebebrand J, Hinney A (2010) Large effects on body mass index and insulin resistance of fat mass and obesity associated gene (FTO) variants in patients with polycystic ovary syndrome (PCOS). BMC Med Genet 11:12

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tan S, Vollmar N, Benson S, Sowa JP, Bechmann LP, Gerken G, Fuhrer D, Canbay A (2015) Liver injury indicating fatty liver but not serologic NASH marker improves under metformin treatment in polycystic ovary syndrome. Int J Endocrinol 2015:254169

    Article  PubMed  PubMed Central  Google Scholar 

  32. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ, International PN (2018) Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 33:1602–1618

    Article  PubMed  PubMed Central  Google Scholar 

  33. Venkatesh SS, Ferreira T, Benonisdottir S, Rahmioglu N, Becker CM, Granne I, Zondervan KT, Holmes MV, Lindgren CM, Wittemans LBL (2022) Obesity and risk of female reproductive conditions: a mendelian randomisation study. PLoS Med 19:e1003679

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wild RA, Rizzo M, Clifton S, Carmina E (2011) Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Fertil Steril 95:1073–1079

    Article  CAS  PubMed  Google Scholar 

  35. Wojciechowski P, Lipowska A, Rys P, Ewens KG, Franks S, Tan S, Lerchbaum E, Vcelak J, Attaoua R, Straczkowski M, Azziz R, Barber TM, Hinney A, Obermayer-Pietsch B, Lukasova P, Bendlova B, Grigorescu F, Kowalska I, Goodarzi MO, Consortium G, Strauss JF 3rd, McCarthy MI, Malecki MT (2012) Impact of FTO genotypes on BMI and weight in polycystic ovary syndrome: a systematic review and meta-analysis. Diabetologia 55:2636–2645

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Wong-Staal F (1985) The oncogene and its potential role in carcinogenesis. Arch Toxicol Suppl 8:61–72

    Article  CAS  PubMed  Google Scholar 

  37. Yang S, Zhao L, He W, Mi Y (2022) The effect of oral antidiabetic drugs on improving the endocrine and metabolic states in women with polycystic ovary syndrome: a systematic review and network meta-analysis. Drugs 82:1469–1480

    Article  CAS  PubMed  Google Scholar 

  38. Yildiz BO, Knochenhauer ES, Azziz R (2008) Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab 93:162–168

    Article  CAS  PubMed  Google Scholar 

  39. Escobar-Morreale HF, San Millan JL (2007) Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab 18:266–272

    Article  CAS  PubMed  Google Scholar 

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  1. Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45721, Essen, Deutschland

    Lukas van Baal &  Susanne Tan

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Correspondence to Susanne Tan.

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S. Tan erklärt, von Novartis eine Förderung zur Durchführung von Studien erhalten zu haben. L. van Baal gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Dagmar Führer-Sakel, Essen

Martin Reincke, München

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van Baal, L., Tan, S. Das polyzystische Ovarsyndrom als genderspezifischer kardiometabolischer Risikofaktor. Innere Medizin 64, 642–648 (2023). https://doi.org/10.1007/s00108-023-01529-7

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