| Abstract | OBJECTIVE: We aimed to determine the impact of medical therapy for symptom management on insulin resistance, metabolic profiles, and surrogate markers of cardiovascular disease in polycystic ovary syndrome (PCOS), an insulin-resistant pre-diabetes condition. RESEARCH DESIGN AND METHODS: One hundred overweight women (BMI >27 kg/m2), average age 31 years, who were nonsmokers, were not pregnant, did not have diabetes, and were off relevant medications for 3 months completed this 6-month open-label controlled trial. Randomization was to a control group (higher-dose oral contraceptive [OCP] 35 microg ethinyl estradiol [EE]/2 mg cyproterone acetate, metformin [1 g b.d.] or low-dose OCP [20 microg EE/100 microg levonorgestrel + aldactone 50 mg b.d.]). Primary outcome measures were insulin resistance (area under curve on oral glucose tolerance test) and surrogate markers of cardiovascular disease including arterial stiffness (pulse wave velocity [PWV]) and endothelial function. RESULTS: All treatments similarly and significantly improved symptoms including hirsutism and menstrual cycle length. Insulin resistance was improved by metformin and worsened by the high-dose OCP. Arterial stiffness worsened in the higher-dose OCP group (PWV 7.46 vs. 8.03 m/s, P < 0.05), related primarily to the increased insulin resistance. CONCLUSIONS: In overweight women with PCOS, metformin and low- and high-dose OCP preparations have similar efficacy but differential effects on insulin resistance and arterial function. These findings suggest that a low-dose OCP preparation may be preferable if contraception is needed and that metformin should be considered for symptomatic management, particularly in women with additional metabolic and cardiovascular risk factors. |
| Authors | Caroline Meyer, Barry P McGrath, Helena Jane Teede
(Affiliation: Centre for Vascular Health, Department of Medicine, Monash University, Melbourne, Victoria, Australia.)
|
| Journal | Diabetes care
(Diabetes Care)
Vol. 30
Issue 3
Pg. 471-8
(Mar 2007)
ISSN: 1935-5548 United States |
| PMID | 17327307
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
|
| Chemical References |
- Contraceptives, Oral
- Insulin
- Metformin
|
| Topics |
- Adult
- Area Under Curve
- Body Mass Index
- Cardiovascular Physiological Phenomena
- Contraceptives, Oral
(therapeutic use)
- Female
- Femoral Artery
(physiopathology)
- Glucose Tolerance Test
- Homeostasis
- Humans
- Insulin
(blood)
- Insulin Resistance
(physiology)
- Metformin
(therapeutic use)
- Models, Biological
- Overweight
- Polycystic Ovary Syndrome
(blood, drug therapy, physiopathology)
|
