January 18, 2018
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PCOS-like characteristics do not raise diabetes risk in women with overweight

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Irregular menses and elevated androgen concentrations did not increase risk for coronary artery calcification or diabetes among women with glucose intolerance or overweight, according to findings published in The Journal of Clinical Endocrinology and Metabolism.

Women with PCOS have greater insulin resistance compared to age- and weight-matched controls and subsequently higher risk of type 2 diabetes,” Catherine Kim, MD, MPH, associate professor of internal medicine at the University of Michigan, and colleagues wrote. “However, the extent to which central PCOS components (ie androgens and irregular menses) increase cardiometabolic risk among women without a diagnosis of PCOS is unclear. Specifically, it is unknown whether these characteristics increase risk beyond the presence of impaired glucose tolerance and overweight alone.”

The researchers performed a secondary analysis of women enrolled in the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study who did not use exogenous estrogen (n = 1,422). All patients were aged 25 years or older and had a BMI of at least 24 kg/m2, or 22 kg/m2 for Asian-American women, as well as a fasting plasma glucose level of 5.3 mmol/L to 7 mmol/L. Kim and colleagues evaluated possible associations between free androgen index or irregular menses and diabetes risk during the study and coronary artery calcification at 10 years, adjusting for race/ethnicity, BMI, age, menopausal status, HbA1c and randomization arm.

Mean age of participants at baseline was 48.2 years.

Elevated androgen concentrations and irregular menses were both associated with greater waist circumference, BMI and blood pressure and lower adiponectin, the researchers reported. However, free androgen index was not associated with risk for diabetes (HR = 0.97; 95% CI, 0.93-1.02) or coronary artery calcification (OR = 1.06; 95% CI, 0.92-1.23).

Similarly, irregular menses was not associated with increased diabetes risk (HR = 1.07; 95% CI, 0.87-1.31) or coronary artery calcification (OR = 0.89; 95% CI, 0.53-1.49). Women with both irregular menses and elevated androgens faced the same diabetes risk and odds of developing coronary artery calcification as those who did not. Researchers reported no differences between treatment arms or menopausal status.

“We conclude that compared to midlife women who are already glucose intolerant and overweight, histories of [irregular menses] and relative elevations in androgens do not additionally increase risk or the burden of subclinical atherosclerosis,” the researchers wrote. “While our report does not rule out that these conditions may identify women at risk in their younger years, it suggests that chronic disease burden in midlife women may be most effectively addressed through weight loss, metformin and the other diabetes prevention measures already known to be beneficial for all women at increased risk for diabetes.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.