Prevalence of Metabolic Syndrome in PCOS Patients

REVIEW
Ilia A. Igumnov, Nadezhda A. Kurashova, Liliya V. Belenkaya, Natalia I. Vilson, Larisa V. Suturina

 
International Journal of Biomedicine. 2022;12(1):95-99.
DOI: 10.21103/Article12(1)_RA5
Originally published March 10, 2022

Abstract: 

The purpose of the review was to systematize the available data on the epidemiology and diagnosis of the metabolic syndrome (MetS) in polycystic ovary syndrome (PCOS). The information search was conducted using Internet resources (PubMed, EMBASE, Google Scholar, E-Library) and literature sources for the years 2000-2020. The modern studies indicate that the prevalence of metabolic disorders varies in groups of women with different PCOS phenotypes. Numerous risk factors in PCOS lead to a significant increase in risk for cardiovascular diseases. Patients with PCOS diagnosed according to AE-PCOS Society criteria have the most severe metabolic features and risk of cardiovascular disease. Hyperandrogenism in PCOS is closely related to the aggravation of abdominal obesity, and together with insulin resistance forms the metabolic core for the development of cardiovascular diseases.

Keywords: 
metabolic syndrome • obesity • insulin resistance • hyperandrogenism • polycystic ovary syndrome
References: 
  1. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005 Oct 25;112(17):2735-52. doi: 10.1161/CIRCULATIONAHA.105.169404. 
  2. Ford ES, Giles WH. A comparison of the prevalence of the metabolic syndrome using two proposed definitions. Diabetes Care. 2003 Mar;26(3):575-81. doi: 10.2337/diacare.26.3.575.
  3. Panov AV, Dikalov SI, Darenskaya MA, Rychkova LV, Kolesnikova LI, Kolesnikov SI. [Mitochondria: Aging, Metabolic Syndrome, and Cardiovascular Pathology. Formation of a new paradigm]. Acta Biomedica Scientifica. 2020;5(4):33-44. doi: 10.29413/ABS.2020-5.4.5. [Article in Russian].
  4. Bahadur A, Mundhra R, Kashibhatla J, Rajput R, Verma N, Kumawat M. Prevalence of metabolic syndrome among women with different PCOS phenotypes - a prospective study. Gynecol Endocrinol. 2021 Jan;37(1):21-25. doi: 10.1080/09513590.2020.1775193.
  5. The Recommendations of the Experts of the All-Russia Scientific Society of Cardiologists for the Diagnosis and Treatment of Metabolic Syndrome. The 2-nd review. Moscow; 2009. [In Russian].
  6. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998 Jul;15(7):539-53. doi: 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S. 
  7. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002 Dec 17;106(25):3143-421. 
  8. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet. 2005 Sep 24-30;366(9491):1059-62. doi: 10.1016/S0140-6736(05)67402-8. 
  9. Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med. 1999 May;16(5):442-3. doi: 10.1046/j.1464-5491.1999.00059.x. 
  10. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009 Oct 20;120(16):1640-5. doi: 10.1161/CIRCULATIONAHA.109.192644. 
  11. Thomas GN, Ho SY, Janus ED, Lam KS, Hedley AJ, Lam TH; Hong Kong Cardiovascular Risk Factor Prevalence Study Steering Committee. The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) prevalence of the metabolic syndrome in a Chinese population. Diabetes Res Clin Pract. 2005 Mar;67(3):251-7. doi: 10.1016/j.diabres.2004.07.022.
  12. Rotar OP, Libis RA, Isaeva EN et al. Metabolic syndrome prevalence in Russian cities. Russian Journal of Cardiology. 2012;17(2):55-62.
  13. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006 May;23(5):469-80. doi: 10.1111/j.1464-5491.2006.01858.x. 
  14. Kolesnikova LI, Kolesnikov SI, Darenskaya MA, Grebenkina LA, Nikitina OA, Lazareva LM, Suturina LV, Danusevich IN, Druzhinina EB, Semendyaev AA. Activity of LPO Processes in Women with Polycystic Ovarian Syndrome and Infertility. Bull Exp Biol Med. 2017 Jan;162(3):320-322. doi: 10.1007/s10517-017-3605-5. 
  15. Suturina LV, Atalyan AV, Darzhaev ZY, et al. Overweight and obesity prevalence in referral population of infertile women with polycystic ovary syndrome. Adv Obes Weight Manag Control. 2017;7(1):237-240. doi: 10.15406/aowmc.2017.07.00188.
  16. Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev. 2016 Oct;37(5):467-520. doi: 10.1210/er.2015-1104. 
  17. Lizneva D, Kirubakaran R, Mykhalchenko K, Suturina L, Chernukha G, Diamond MP, Azziz R. Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations: systematic review and meta-analysis. Fertil Steril. 2016 Nov;106(6):1510-1520.e2. doi: 10.1016/j.fertnstert.2016.07.1121. 
  18. Wijeyaratne CN, Balen AH, Barth JH, Belchetz PE. Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among South Asians and Caucasians: is there a difference? Clin Endocrinol (Oxf). 2002 Sep;57(3):343-50. doi: 10.1046/j.1365-2265.2002.01603.x. 
  19. Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016 Jul;106(1):6-15. doi: 10.1016/j.fertnstert.2016.05.003.
  20. Li R, Zhang Q, Yang D, Li S, Lu S, Wu X, Wei Z, Song X, Wang X, Fu S, Lin J, Zhu Y, Jiang Y, Feng HL, Qiao J. Prevalence of polycystic ovary syndrome in women in China: a large community-based study. Hum Reprod. 2013 Sep;28(9):2562-9. doi: 10.1093/humrep/det262. 
  21. Belenkaia LV, Lazareva LM, Walker W, Lizneva DV, Suturina LV. Criteria, phenotypes and prevalence of polycystic ovary syndrome. Minerva Ginecol. 2019 Jun;71(3):211-223. doi: 10.23736/S0026-4784.19.04404-6. 
  22. Zore T, Joshi NV, Lizneva D, Azziz R. Polycystic Ovarian Syndrome: Long-Term Health Consequences. Semin Reprod Med. 2017 May;35(3):271-281. doi: 10.1055/s-0037-1603096.
  23. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010 Feb;25(2):544-51. doi: 10.1093/humrep/dep399. 
  24. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004 Jan;19(1):41-7. doi: 10.1093/humrep/deh098.
  25. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF; Androgen Excess Society. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006 Nov;91(11):4237-45. doi: 10.1210/jc.2006-0178. 
  26. Carmina E, Azziz R. Diagnosis, phenotype, and prevalence of polycystic ovary syndrome. Fertil Steril. 2006 Jul;86 Suppl 1:S7-8. doi: 10.1016/j.fertnstert.2006.03.012. 
  27. Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018 Aug;132(2):321-336. doi: 10.1097/AOG.0000000000002698.
  28. Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Consensus on women's health aspects of polycystic ovary syndrome (PCOS). Hum Reprod. 2012 Jan;27(1):14-24. doi: 10.1093/humrep/der396.
  29. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF; Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009 Feb;91(2):456-88. doi: 10.1016/j.fertnstert.2008.06.035.
  30. Karee M, Gundabattula SR, Sashi L, Boorugu H, Chowdhury A. Prevalence of metabolic syndrome in women with polycystic ovary syndrome and the factors associated: A cross sectional study at a tertiary care center in Hyderabad, south-eastern India. Diabetes Metab Syndr. 2020 Jul-Aug;14(4):583-587. doi: 10.1016/j.dsx.2020.05.006. 
  31. Anastasiou OE, Canbay A, Fuhrer D, Reger-Tan S. Metabolic and androgen profile in underweight women with polycystic ovary syndrome. Arch Gynecol Obstet. 2017 Aug;296(2):363-371. doi: 10.1007/s00404-017-4422-9. 
  32. Kim JJ, Hwang KR, Oh SH, Chae SJ, Yoon SH, Choi YM. Prevalence of insulin resistance in Korean women with polycystic ovary syndrome according to various homeostasis model assessment for insulin resistance cutoff values. Fertil Steril. 2019 Nov;112(5):959-966.e1. doi: 10.1016/j.fertnstert.2019.06.035.
  33. Carmina E, Napoli N, Longo RA, Rini GB, Lobo RA. Metabolic syndrome in polycystic ovary syndrome (PCOS): lower prevalence in southern Italy than in the USA and the influence of criteria for the diagnosis of PCOS. Eur J Endocrinol. 2006 Jan;154(1):141-5. doi: 10.1530/eje.1.02058. 
  34. Dargham SR, Ahmed L, Kilpatrick ES, Atkin SL. The prevalence and metabolic characteristics of polycystic ovary syndrome in the Qatari population. PLoS One. 2017 Jul 19;12(7):e0181467. doi: 10.1371/journal.pone.0181467. 
  35. Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Noroozzadeh M, Farahmand M, Rostami Dovom M, Ramezani Tehrani F. The risk of metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018 Feb;88(2):169-184. doi: 10.1111/cen.13477.
  36. Essah PA, Nestler JE. Metabolic syndrome in women with polycystic ovary syndrome. Fertil Steril. 2006 Jul;86 Suppl 1:S18-9. doi: 10.1016/j.fertnstert.2006.04.013. 
  37. Soares EM, Azevedo GD, Gadelha RG, Lemos TM, Maranhão TM. Prevalence of the metabolic syndrome and its components in Brazilian women with polycystic ovary syndrome. Fertil Steril. 2008 Mar;89(3):649-55. doi: 10.1016/j.fertnstert.2007.03.081. 
  38. Cheung LP, Ma RC, Lam PM, Lok IH, Haines CJ, So WY, Tong PC, Cockram CS, Chow CC, Goggins WB. Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome. Hum Reprod. 2008 Jun;23(6):1431-8. doi: 10.1093/humrep/den090. 
  39. Vrbíková J, Vondra K, Cibula D, Dvoráková K, Stanická S, Srámková D, Sindelka G, Hill M, Bendlová B, Skrha J. Metabolic syndrome in young Czech women with polycystic ovary syndrome. Hum Reprod. 2005 Dec;20(12):3328-32. doi: 10.1093/humrep/dei221. 
  40. Glueck CJ, Papanna R, Wang P, Goldenberg N, Sieve-Smith L. Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism. 2003 Jul;52(7):908-15. doi: 10.1016/s0026-0495(03)00104-5. 
  41. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005 Apr;90(4):1929-35. doi: 10.1210/jc.2004-1045.
  42. Mandrelle K, Kamath MS, Bondu DJ, Chandy A, Aleyamma T, George K. Prevalence of metabolic syndrome in women with polycystic ovary syndrome attending an infertility clinic in a tertiary care hospital in south India. J Hum Reprod Sci. 2012 Jan;5(1):26-31. doi: 10.4103/0974-1208.97791.
  43. Wijeyaratne CN, Balen AH, Barth JH, Belchetz PE. Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among South Asians and Caucasians: is there a difference? Clin Endocrinol (Oxf). 2002 Sep;57(3):343-50. doi: 10.1046/j.1365-2265.2002.01603.x. 
  44. Carmina E, Nasrallah MP, Guastella E, Lobo RA. Characterization of metabolic changes in the phenotypes of women with polycystic ovary syndrome in a large Mediterranean population from Sicily. Clin Endocrinol (Oxf). 2019 Oct;91(4):553-560. doi: 10.1111/cen.14063. 
  45. Çelik E, Türkçüoğlu I, Ata B, Karaer A, Kırıcı P, Eraslan S, Taşkapan Ç, Berker B. Metabolic and carbohydrate characteristics of different phenotypes of polycystic ovary syndrome. J Turk Ger Gynecol Assoc. 2016 Dec 1;17(4):201-208. doi: 10.5152/jtgga.2016.16133. 
  46. Moran L, Teede H. Metabolic features of the reproductive phenotypes of polycystic ovary syndrome. Hum Reprod Update. 2009 Jul-Aug;15(4):477-88. doi: 10.1093/humupd/dmp008. 
  47. Rizzo M, Berneis K, Hersberger M, Pepe I, Di Fede G, Rini GB, Spinas GA, Carmina E. Milder forms of atherogenic dyslipidemia in ovulatory versus anovulatory polycystic ovary syndrome phenotype. Hum Reprod. 2009 Sep;24(9):2286-92. doi: 10.1093/humrep/dep121.

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Received December 16, 2021.
Accepted February 7, 2022.
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