Original Article Gynecol Obstet Invest 2014;78:173–178 DOI: 10.1159/000363744
Received: May 27, 2013 Accepted after revision: May 18, 2014 Published online: July 9, 2014
Is Pentraxin 3 a New Cardiovascular Risk Marker in Polycystic Ovary Syndrome? Umut Sari a Ikbal Kaygusuz b Hasan Kafali c a
Department of Obstetrics and Gynecology, Acibadem Levent Medical Center, Istanbul, b Department of Obstetrics and Gynecology, Turgut Ozal University Medical School, and c Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara, Turkey
Key Words Pentraxin 3 · Polycystic ovary syndrome · Cardiovascular disease · Body mass index · Insulin resistance
Abstract Background/Aims: Polycystic ovary syndrome (PCOS) patients have an increased rate of subclinical inflammation, which plays a role in the pathogenesis of atherosclerosis. Pentraxin 3 (PTX3) is an inflammatory mediator which belongs to the same family as the well-established cardiovascular biomarker C-reactive protein (CRP). The present study was performed to investigate plasma PTX3 levels in patients with PCOS and to determine the relationship between PTX3 and other known cardiovascular risk factors. Methods: 40 patients with PCOS and 40 age- and BMImatched healthy controls were included in the study. The groups were divided into subgroups according to BMI. Insulin resistance indexes, lipid profile, CRP and PTX3 levels were analyzed. Results: There was no difference for insulin
© 2014 S. Karger AG, Basel 0378–7346/14/0783–0173$39.50/0 E-Mail [email protected] www.karger.com/goi
resistance indexes and lipid profile between the PCOS and control groups. CRP levels were significantly higher in obese PCOS and control subjects than in lean subjects, whereas no difference in PTX3 concentrations was observed between subgroups. Conclusion: PTX3 and CRP levels were similar in the PCOS group compared with the nonPCOS control group. © 2014 S. Karger AG, Basel
Introduction
Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine disorders in women of reproductive age, affecting 5–10% of women in this period of life [1]. It is a major cause of menstrual disturbances, hirsutism, and female anovulatory infertility [2]. Moreover, PCOS is associated with long-term health risks, including cardiovascular disease (CVD), diabetes mellitus, hypertension, endometrial carcinoma [3]. Ikbal Kaygusuz, MD Department of Obstetrics and Gynecology, Turgut Ozal University Faculty of Medicine Ciftlik Cad. No. 57 06510 TR–06510 Emek/Ankara (Turkey) E-Mail ikbal_cekmen @ yahoo.com
Over the last years it has been reported that PCOS patients are at increased risk for CVD. A 7-fold higher risk for myocardial infarction in women with PCOS [4] and a 3.3-fold higher risk of cardiovascular death in postmenopausal women with clinical features of PCOS have been recently reported [5]. It is a fact that predetermination of CVD risk will help to prevent long-term complications. Most studies have suggested that insulin resistance (IR), obesity, dyslipidemia, hyperandrogenism, and hypertension and low-grade chronic inflammation are high-risk factors for increased CVD in patients with PCOS [6–8]. Pentraxin 3 (PTX3) is a novel multimeric acute phase inflammatory glycoprotein belonging to the same family as the well-established cardiovascular biomarker C-reactive protein (CRP) [9, 10]. PTX3 is expressed in endothelial cells, macrophages, myeloid cells and dendritic cells [11], suggesting that PTX3 may contribute to the pathogenesis of atherosclerosis [12]. High PTX3 levels have been associated with unstable angina [13], adverse outcome after myocardial infarction [14] and heart failure [15]. The present study was performed to investigate plasma PTX3 levels in patients with PCOS and to determine the relationship between PTX3 and other known cardiovascular risk factors.
Table 1. Clinical and hormonal data of PCOS and control groups
PCOS (n = 40)
Control (n = 40)
Age, years 24.72 ± 6.18 BMI 28.80 (14.00) WHR 0.76 ± 0.10 FSH, mIU/ml 5.68 ± 1.88 LH, mIU/ml 6.50 (3.00) E2, pg/ml 38.90 (16.00) LH/FSH 1.46 ± 1.16 TSH, mIU/ml 2.92 (1.00) PRL, mIU/ml 341.30 ± 139.08 DHEA-S, μg/dl 230.18 ± 118.56 TT, ng/dl 56.19 ± 26.17 17-OH-P, ng/ml 1.00 (1.00) FI, mIU/ml 10.90 (10.00) FG/FI 8.09 (6.53) HOMA-IR 2.40 (3.00) OGTT 120 min, mg/dl 98.00 (33.00) HDL, mg/dl 51.00 (14.00) LDL, g/dl 94.50 (37.00) TG, mg/dl 89.00 (41.00) CRP, mg/l 4.00 (4.00) PTX3, ng/ml 0.65 (1.28)
p
25.88 ± 4.51 0.29 25.00 (15.00) 0.69* 0.74 ± 0.11 0.40 6.52 ± 1.89 0.05 5.25 (3.00) 0.01* 42.00 (25.00) 0.23* 0.93 ± 0.58 0.01 2.48 (3.00) 0.95* 316.52 ± 98.27 0.36 218.72 ± 84.50 0.62 31.81 ± 16.75 ≤0.001 0.80 (0.00) 0.595* 9.30 (8.00) 0.301* 10.22 (10.19) 0.248* 2.05 (2.00) 0.614* 89.00 (27.50) 0.32* 51.00 (18.00) 0.90* 90.00 (40.00) 0.55* 94.00 (74.00) 0.66* 3.75 (4.00) 0.90* 0.89 (0.72) 0.09*
Data are means ± SD, or median (IQR). p values represent the significance level of Student’s t test. * Significance level of the Mann-Whitney U test.
Material and Methods This cross-sectional study was performed at the Medical School of Fatih University, Ankara, Turkey, between 2008 and 2009 years. 47 regularly menstruating healthy non-hirsute, normoovulatory women and 45 newly diagnosed PCOS patients took part in the study, a total of 92 cases. The groups were divided into subgroups according to BMI ≥25 or
Received: May 27, 2013 Accepted after revision: May 18, 2014 Published online: July 9, 2014
Is Pentraxin 3 a New Cardiovascular Risk Marker in Polycystic Ovary Syndrome? Umut Sari a Ikbal Kaygusuz b Hasan Kafali c a
Department of Obstetrics and Gynecology, Acibadem Levent Medical Center, Istanbul, b Department of Obstetrics and Gynecology, Turgut Ozal University Medical School, and c Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara, Turkey
Key Words Pentraxin 3 · Polycystic ovary syndrome · Cardiovascular disease · Body mass index · Insulin resistance
Abstract Background/Aims: Polycystic ovary syndrome (PCOS) patients have an increased rate of subclinical inflammation, which plays a role in the pathogenesis of atherosclerosis. Pentraxin 3 (PTX3) is an inflammatory mediator which belongs to the same family as the well-established cardiovascular biomarker C-reactive protein (CRP). The present study was performed to investigate plasma PTX3 levels in patients with PCOS and to determine the relationship between PTX3 and other known cardiovascular risk factors. Methods: 40 patients with PCOS and 40 age- and BMImatched healthy controls were included in the study. The groups were divided into subgroups according to BMI. Insulin resistance indexes, lipid profile, CRP and PTX3 levels were analyzed. Results: There was no difference for insulin
© 2014 S. Karger AG, Basel 0378–7346/14/0783–0173$39.50/0 E-Mail [email protected] www.karger.com/goi
resistance indexes and lipid profile between the PCOS and control groups. CRP levels were significantly higher in obese PCOS and control subjects than in lean subjects, whereas no difference in PTX3 concentrations was observed between subgroups. Conclusion: PTX3 and CRP levels were similar in the PCOS group compared with the nonPCOS control group. © 2014 S. Karger AG, Basel
Introduction
Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine disorders in women of reproductive age, affecting 5–10% of women in this period of life [1]. It is a major cause of menstrual disturbances, hirsutism, and female anovulatory infertility [2]. Moreover, PCOS is associated with long-term health risks, including cardiovascular disease (CVD), diabetes mellitus, hypertension, endometrial carcinoma [3]. Ikbal Kaygusuz, MD Department of Obstetrics and Gynecology, Turgut Ozal University Faculty of Medicine Ciftlik Cad. No. 57 06510 TR–06510 Emek/Ankara (Turkey) E-Mail ikbal_cekmen @ yahoo.com
Over the last years it has been reported that PCOS patients are at increased risk for CVD. A 7-fold higher risk for myocardial infarction in women with PCOS [4] and a 3.3-fold higher risk of cardiovascular death in postmenopausal women with clinical features of PCOS have been recently reported [5]. It is a fact that predetermination of CVD risk will help to prevent long-term complications. Most studies have suggested that insulin resistance (IR), obesity, dyslipidemia, hyperandrogenism, and hypertension and low-grade chronic inflammation are high-risk factors for increased CVD in patients with PCOS [6–8]. Pentraxin 3 (PTX3) is a novel multimeric acute phase inflammatory glycoprotein belonging to the same family as the well-established cardiovascular biomarker C-reactive protein (CRP) [9, 10]. PTX3 is expressed in endothelial cells, macrophages, myeloid cells and dendritic cells [11], suggesting that PTX3 may contribute to the pathogenesis of atherosclerosis [12]. High PTX3 levels have been associated with unstable angina [13], adverse outcome after myocardial infarction [14] and heart failure [15]. The present study was performed to investigate plasma PTX3 levels in patients with PCOS and to determine the relationship between PTX3 and other known cardiovascular risk factors.
Table 1. Clinical and hormonal data of PCOS and control groups
PCOS (n = 40)
Control (n = 40)
Age, years 24.72 ± 6.18 BMI 28.80 (14.00) WHR 0.76 ± 0.10 FSH, mIU/ml 5.68 ± 1.88 LH, mIU/ml 6.50 (3.00) E2, pg/ml 38.90 (16.00) LH/FSH 1.46 ± 1.16 TSH, mIU/ml 2.92 (1.00) PRL, mIU/ml 341.30 ± 139.08 DHEA-S, μg/dl 230.18 ± 118.56 TT, ng/dl 56.19 ± 26.17 17-OH-P, ng/ml 1.00 (1.00) FI, mIU/ml 10.90 (10.00) FG/FI 8.09 (6.53) HOMA-IR 2.40 (3.00) OGTT 120 min, mg/dl 98.00 (33.00) HDL, mg/dl 51.00 (14.00) LDL, g/dl 94.50 (37.00) TG, mg/dl 89.00 (41.00) CRP, mg/l 4.00 (4.00) PTX3, ng/ml 0.65 (1.28)
p
25.88 ± 4.51 0.29 25.00 (15.00) 0.69* 0.74 ± 0.11 0.40 6.52 ± 1.89 0.05 5.25 (3.00) 0.01* 42.00 (25.00) 0.23* 0.93 ± 0.58 0.01 2.48 (3.00) 0.95* 316.52 ± 98.27 0.36 218.72 ± 84.50 0.62 31.81 ± 16.75 ≤0.001 0.80 (0.00) 0.595* 9.30 (8.00) 0.301* 10.22 (10.19) 0.248* 2.05 (2.00) 0.614* 89.00 (27.50) 0.32* 51.00 (18.00) 0.90* 90.00 (40.00) 0.55* 94.00 (74.00) 0.66* 3.75 (4.00) 0.90* 0.89 (0.72) 0.09*
Data are means ± SD, or median (IQR). p values represent the significance level of Student’s t test. * Significance level of the Mann-Whitney U test.
Material and Methods This cross-sectional study was performed at the Medical School of Fatih University, Ankara, Turkey, between 2008 and 2009 years. 47 regularly menstruating healthy non-hirsute, normoovulatory women and 45 newly diagnosed PCOS patients took part in the study, a total of 92 cases. The groups were divided into subgroups according to BMI ≥25 or
