Progression of glucose intolerance and cardiometabolic risk factors over a decade in Chinese women with polycystic ovary syndrome: A case-control study


Autoři: Noel Yat Hey Ng aff001;  Guozhi Jiang aff001;  Lai Ping Cheung aff003;  Yuying Zhang aff001;  Claudia Ha Ting Tam aff001;  Andrea On Yan Luk aff001;  Jianchao Quan aff005;  Eric Siu Him Lau aff006;  Tiffany Tse Ling Yau aff001;  Michael Ho Ming Chan aff007;  Chung Shun Ho aff007;  Cadmon King Poo Lim aff001;  Risa Ozaki aff001;  Jin Huang aff003;  Kin Hung Liu aff008;  Wing Hung Tam aff003;  Daljit Singh Sahota aff003;  Winnie Chiu Wing Chu aff008;  William Goggins aff009;  Jean Woo aff001;  Tin Chiu Li aff003;  Chun Chung Chow aff001;  Juliana Chung Ngor Chan aff001;  Ronald Ching Wan Ma aff001
Působiště autorů: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China aff001;  Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China aff002;  Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China aff003;  Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China aff004;  Division of Health Economics, Policy and Management, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China aff005;  Asia Diabetes Foundation, Hong Kong Special Administrative Region, People’s Republic of China aff006;  Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, People’s Republic of China aff007;  Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China aff008;  Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China aff009;  Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong Special Administrative Region, People’s Republic of China aff010
Vyšlo v časopise: Progression of glucose intolerance and cardiometabolic risk factors over a decade in Chinese women with polycystic ovary syndrome: A case-control study. PLoS Med 16(10): e32767. doi:10.1371/journal.pmed.1002953
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1002953

Souhrn

Background

Polycystic ovary syndrome (PCOS) is associated with increased metabolic risk, though data on long-term follow-up of cardiometabolic traits are limited. We postulated that Chinese women with PCOS would have higher risk of incident diabetes and cardiometabolic abnormalities than those without PCOS during long-term follow-up.

Methods and findings

One hundred ninety-nine Chinese women with PCOS diagnosed by the Rotterdam criteria and with a mean age of 41.2 years (SD = 6.4) completed a follow-up evaluation after an average of 10.6 ± 1.3 years. Two hundred twenty-five women without PCOS (mean age: 54.1 ± 6.7 years) who underwent baseline and follow-up evaluation over the same period were used for comparison. Progression of glycaemic status of women both with and without PCOS was assessed by using 75-g oral glucose tolerance test (OGTT) screening with the adoption of 2009 American Diabetes Association diagnostic criteria. The frequency of impaired glucose regulation, hypertension, and hyperlipidaemia of women with PCOS at follow-up has increased from 31.7% (95% CI 25.2%–38.1%) to 47.2% (95% CI 40.3%–54.2%), 16.1% (95% CI 11.0%–21.2%) to 34.7% (95% CI 28.1%–41.3%), and 52.3% (95% CI 45.3%–59.2%) to 64.3% (95% CI 57.7%–71.0%), respectively. The cumulative incidence of diabetes mellitus (DM) in follow-up women with PCOS is 26.1% (95% CI 20.0%–32.2%), almost double that in the cohort of women without PCOS (p < 0.001). Age-standardised incidence of diabetes among women with PCOS was 22.12 per 1,000 person-years (95% CI 10.86–33.37) compared with the local female population incidence rate of 8.76 per 1,000 person-years (95% CI 8.72–8.80) and 10.09 per 1,000 person-years (95% CI 4.92–15.26, p < 0.001) for women without PCOS in our study. Incidence rate for women with PCOS aged 30–39 years was 20.56 per 1,000 person-years (95% CI 12.57–31.87), which is approximately 10-fold higher than that of the age-matched general female population in Hong Kong (1.88 per 1,000 person-years, [95% CI 1.85–1.92]). The incidence rate of type 2 DM (T2DM) of both normal-weight and overweight women with PCOS was around double that of corresponding control groups (normal weight: 8.96 [95% CI 3.92–17.72] versus 4.86 per 1,000 person-years [95% CI 2.13–9.62], p > 0.05; overweight/obese: 28.64 [95% CI 19.55–40.60] versus 14.1 per 1,000 person-years [95% CI 8.20–22.76], p < 0.05). Logistic regression analysis identified that baseline waist-to-hip ratio (odds ratio [OR] = 1.71 [95% CI 1.08–2.69], p < 0.05) and elevated triglyceride (OR = 6.63 [95% CI 1.23–35.69], p < 0.05) are associated with the progression to T2DM in PCOS. Limitations of this study include moderate sample size with limited number of incident diabetes during follow-up period and potential selection bias.

Conclusions

High risk of diabetes and increased cardiovascular disease risk factors among Chinese women with PCOS are highlighted in this long-term follow-up study. Diabetes onset was, on average, 10 years earlier among women with PCOS than in women without PCOS.

Klíčová slova:

Hong Kong – Chinese people – Obesity – Polycystic ovary syndrome – Testosterone – Women's health


Zdroje

1. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of Impaired Glucose Tolerance and Diabetes in Women with Polycystic Ovary Syndrome. Diabetes Care. 1999;22(1):141–6. doi: 10.2337/diacare.22.1.141 10333916

2. Joham AE, Ranasinha S, Zoungas S, Moran L, Teede HJ. Gestational Diabetes and Type 2 Diabetes in Reproductive-Aged Women with Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2014;99(3):E447–52. doi: 10.1210/jc.2013-2007 24081730

3. Dunaif A. Insulin Resistance and the Polycystic Ovary Syndrome: Mechanism and Implications for Pathogenesis. Endocr Rev. 1997;18(6):774–800. doi: 10.1210/edrv.18.6.0318 9408743

4. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired Glucose Tolerance, Type 2 Diabetes and Metabolic Syndrome in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Hum Reprod Update. 2010;16(4):347–63. doi: 10.1093/humupd/dmq001 20159883

5. Jayasena CN, Franks S. The Management of Patients with Polycystic Ovary Syndrome. Nat Rev Endocrinol. 2014;10(10):624–36. doi: 10.1038/nrendo.2014.102 25022814

6. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and Predictors of Risk for Type 2 Diabetes Mellitus and Impaired Glucose Tolerance in Polycystic Ovary Syndrome: A Prospective, Controlled Study in 254 Affected Women. J Clin Endocrinol Metab. 1999;84(1):165–9. doi: 10.1210/jcem.84.1.5393 9920077

7. Celik C, Tasdemir N, Abali R, Bastu E, Yilmaz M. Progression to Impaired Glucose Tolerance or Type 2 Diabetes Mellitus in Polycystic Ovary Syndrome: A Controlled Follow-up Study. Fertil Steril. 2014;101(4):1123-8.e1. 24502891

8. Kakoly NS, Khomami MB, Joham AE, Cooray SD, Misso ML, Norman RJ, et al. Ethnicity, Obesity and the Prevalence of Impaired Glucose Tolerance and Type 2 Diabetes in Pcos: A Systematic Review and Meta-Regression. Hum Reprod Update. 2018;24(4):455–67. doi: 10.1093/humupd/dmy007 29590375

9. Cheung LP, Ma RC, Lam PM, Lok IH, Haines CJ, So WY, et al. Cardiovascular Risks and Metabolic Syndrome in Hong Kong Chinese Women with Polycystic Ovary Syndrome. Hum Reprod. 2008;23(6):1431–8. doi: 10.1093/humrep/den090 18359783

10. The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome. Fertil Steril. 2004;81(1):19. doi: 10.1016/j.fertnstert.2003.10.004 14711538

11. Ko GT, Chan JC, Chan AW, Wong PT, Hui SS, Tong SD, et al. Association between Sleeping Hours, Working Hours and Obesity in Hong Kong Chinese: The 'Better Health for Better Hong Kong' Health Promotion Campaign. Int J Obes (Lond). 2007;31(2):254–60.

12. Zhang Y, Luk AOY. High Risk of Conversion to Diabetes in First-Degree Relatives of Individuals with Young-Onset Type 2 Diabetes: A 12-Year Follow-up Analysis. Diabet Med. 2017;34(12):1701–9. 28945282

13. Ho CS. Female Androgen Profiles by Ms for Pcos Patients. Hong Kong: APCCMS; 2010.

14. American Diabetes Association. Standards of Medical Care in Diabetes—2009. Diabetes Care. 2009;32(Suppl 1):S13–S61.

15. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (Jnc 8). Jama. 2014;311(5):507–20. doi: 10.1001/jama.2013.284427 24352797

16. Quan J, Li TK, Pang H, Choi CH, Siu SC, Tang SY, et al. Diabetes Incidence and Prevalence in Hong Kong, China During 2006–2014. Diabet Med. 2017;34(7):902–8. doi: 10.1111/dme.13284 27859570

17. World Health Organization. Obesity: Preventing and Managing the Global Epidemic: Report of a Who Consultation. Geneva: World Health Organization; 2000. 253 s. p.

18. Gambineri A, Patton L, Altieri P, Pagotto U, Pizzi C, Manzoli L, et al. Polycystic Ovary Syndrome Is a Risk Factor for Type 2 Diabetes: Results from a Long-Term Prospective Study. Diabetes. 2012;61(9):2369–74. doi: 10.2337/db11-1360 22698921

19. Teede HJ, Joham AE, Paul E, Moran LJ, Loxton D, Jolley D, et al. Longitudinal Weight Gain in Women Identified with Polycystic Ovary Syndrome: Results of an Observational Study in Young Women. Obesity (Silver Spring). 2013;21(8):1526–32.

20. Jacewicz-Swiecka M, Kowalska I. Polycystic Ovary Syndrome and the Risk of Cardio-Metabolic Complications in Longitudinal Studies: A Review of the Data. Diabetes Metab Res Rev. 2018;34(8):e3054. doi: 10.1002/dmrr.3054 30089337

21. Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose Intolerance in Polycystic Ovary Syndrome—a Position Statement of the Androgen Excess Society. J Clin Endocrinol Metab. 2007;92(12):4546–56. doi: 10.1210/jc.2007-1549 18056778

22. DeUgarte CM, Woods KS, Bartolucci AA, Azziz R. Degree of Facial and Body Terminal Hair Growth in Unselected Black and White Women: Toward a Populational Definition of Hirsutism. J Clin Endocrinol Metab. 2006;91(4):1345–50. doi: 10.1210/jc.2004-2301 16449347

23. Huddleston HG, Cedars MI, Sohn SH, Giudice LC, Fujimoto VY. Racial and Ethnic Disparities in Reproductive Endocrinology and Infertility. Am J Obstet Gynecol. 2010;202(5):413–9. doi: 10.1016/j.ajog.2009.12.020 20207341

24. Ma RC, Chan JC. Type 2 Diabetes in East Asians: Similarities and Differences with Populations in Europe and the United States. Ann N Y Acad Sci. 2013;1281:64–91. doi: 10.1111/nyas.12098 23551121

25. Zhao Y, Qiao J. Ethnic Differences in the Phenotypic Expression of Polycystic Ovary Syndrome. Steroids. 2013;78(8):755–60. doi: 10.1016/j.steroids.2013.04.006 23624030

26. Chan JC, Lau ES, Luk AO, Cheung KK, Kong AP, Yu LW, et al. Premature Mortality and Comorbidities in Young-Onset Diabetes: A 7-Year Prospective Analysis. Am J Med. 2014;127(7):616–24. doi: 10.1016/j.amjmed.2014.03.018 24680795

27. Hillier TA, Pedula KL. Complications in Young Adults with Early-Onset Type 2 Diabetes. Losing the relative protection of youth. Diabetes Care. 2003;26(11):2999–3005.

28. Morgan CL, Jenkins-Jones S, Currie CJ, Rees DA. Evaluation of Adverse Outcome in Young Women with Polycystic Ovary Syndrome Versus Matched, Reference Controls: A Retrospective, Observational Study. J Clin Endocrinol Metab. 2012;97(9):3251–60. doi: 10.1210/jc.2012-1690 22767635

29. Mani H, Levy MJ, Davies MJ, Morris DH, Gray LJ, Bankart J, et al. Diabetes and Cardiovascular Events in Women with Polycystic Ovary Syndrome: A 20-Year Retrospective Cohort Study. Clin Endocrinol (Oxf). 2013;78(6):926–34.

30. Ramezani Tehrani F, Montazeri SA, Hosseinpanah F, Cheraghi L, Erfani H, Tohidi M, et al. Trend of Cardio-Metabolic Risk Factors in Polycystic Ovary Syndrome: A Population-Based Prospective Cohort Study. PLoS ONE. 2015;10(9):e0137609. doi: 10.1371/journal.pone.0137609 26360602

31. Rubin KH, Glintborg D, Nybo M, Abrahamsen B, Andersen M. Development and Risk Factors of Type 2 Diabetes in a Nationwide Population of Women with Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2017;102(10):3848–57. doi: 10.1210/jc.2017-01354 28938447

32. Ollila ME, West S, Keinanen-Kiukaanniemi S, Jokelainen J, Auvinen J, Puukka K, et al. Overweight and Obese but Not Normal Weight Women with Pcos Are at Increased Risk of Type 2 Diabetes Mellitus-a Prospective, Population-Based Cohort Study. Hum Reprod. 2017;32(2):423–31. doi: 10.1093/humrep/dew329 28031324

33. Pelanis R, Mellembakken JR, Sundstrom-Poromaa I, Ravn P, Morin-Papunen L, Tapanainen JS, et al. The Prevalence of Type 2 Diabetes Is Not Increased in Normal-Weight Women with Pcos. Hum Reprod. 2017;32(11):2279–86. doi: 10.1093/humrep/dex294 29040530

34. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertil Steril. 2018;110(3):364–79. doi: 10.1016/j.fertnstert.2018.05.004 30033227

35. Ashwell M, Gunn P, Gibson S. Waist-to-Height Ratio Is a Better Screening Tool Than Waist Circumference and Bmi for Adult Cardiometabolic Risk Factors: Systematic Review and Meta-Analysis. Obesity Reviews. 2012;13(3):275–86. doi: 10.1111/j.1467-789X.2011.00952.x 22106927

36. Kakoly NS, Earnest A, Moran LJ, Teede HJ, Joham AE. Group-Based Developmental Bmi Trajectories, Polycystic Ovary Syndrome, and Gestational Diabetes: A Community-Based Longitudinal Study. BMC medicine. 2017;15(1):195. doi: 10.1186/s12916-017-0957-7 29110650

37. Sam S. Obesity and Polycystic Ovary Syndrome. Obesity management. 2007;3(2):69–73. doi: 10.1089/obe.2007.0019 20436797

38. Teede H, Deeks A, Moran L. Polycystic Ovary Syndrome: A Complex Condition with Psychological, Reproductive and Metabolic Manifestations That Impacts on Health across the Lifespan. BMC medicine. 2010;8(1):41.

39. Corbould A. Effects of Androgens on Insulin Action in Women: Is Androgen Excess a Component of Female Metabolic Syndrome? Diabetes Metab Res Rev. 2008;24(7):520–32. doi: 10.1002/dmrr.872 18615851

40. Pinola P, Puukka K, Piltonen TT, Puurunen J, Vanky E, Sundstrom-Poromaa I, et al. Normo- and Hyperandrogenic Women with Polycystic Ovary Syndrome Exhibit an Adverse Metabolic Profile through Life. Fertil Steril. 2017;107(3):788-95.e2.

41. Legro RS, Schlaff WD, Diamond MP, Coutifaris C, Casson PR, Brzyski RG, et al. Total Testosterone Assays in Women with Polycystic Ovary Syndrome: Precision and Correlation with Hirsutism. J Clin Endocrinol Metab. 2010;95(12):5305–13. doi: 10.1210/jc.2010-1123 20826578

42. Fritz MA. Clinical Gynecologic Endocrinology and Infertility. In: Speroff L, editor. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011.

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Interní lékařství

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