The effect of atorvastatin in patients with polycystic ovary syndrome: a randomized double-blind placebo-controlled study.

Abstract

CONTEXT:

Polycystic ovary syndrome (PCOS) is associated with increased risk of cardiovascular morbidity, whereas statins are proven to reduce cardiovascular mortality and morbidity through lipid-lowering and perhaps through their pleiotropic effects. Statins can also reduce testosterone in vitro by inhibiting ovarian theca-interstitial cell proliferation and steroidogenesis and reducing inflammation in vivo.

OBJECTIVE:

Our objective was to assess the effect of atorvastatin on inflammatory markers, insulin resistance, and biochemical hyperandrogenemia in patients with PCOS.

DESIGN AND SETTING:

We conducted a randomized, double-blind, placebo-controlled study at a tertiary care setting in United Kingdom.

PATIENTS:

Patients included 40 medication-naive patients with PCOS and biochemical hyperandrogenemia.

METHODS:

Patients were randomized to either atorvastatin 20 mg daily or placebo.

MAIN OUTCOME MEASURES:

The primary endpoint of the study was a change in the inflammatory marker high-sensitivity C-reactive protein. The secondary endpoints were a change in insulin resistance and total testosterone.

RESULTS:

After 12 wk atorvastatin, there was a significant reduction (mean +/- sem) in total cholesterol (4.6 +/- 0.2 vs. 3.4 +/- 0.2 mmol/liter, P < 0.01), low-density lipoprotein cholesterol (2.9 +/- 0.2 vs. 1.8 +/- 0.2 mmol/liter, P < 0.01), triglycerides (1.34 +/- 0.08 vs. 1.08 +/- 0.13 mmol/liter, P <0.01), high-sensitivity C-reactive protein (4.9 +/- 1.4 vs. 3.4 +/- 1.1 mg/liter, P = 0.04), free androgen index (13.4 +/- 0.6 vs. 8.7 +/- 0.4, P < 0.01), testosterone (4.1 +/- 0.2 vs. 2.9 +/- 0.1 nmol/liter, P < 0.01) and insulin resistance as measured by homeostasis model assessment for insulin resistance (HOMA-IR) (3.3 +/- 0.4 vs. 2.7 +/- 0.4). There was a significant increase in SHBG (31.1 +/- 1.0 vs. 35.3 +/- 1.2 nmol/liter, P < 0.01). There was a positive correlation between the reduction in HOMA-IR in the atorvastatin group with the reduction in triglycerides and the reduction of free androgen index. There was a significant deterioration of HOMA-IR in the placebo group (3.0 +/- 0.4 vs. 3.8 +/- 0.5).

CONCLUSIONS:

This study suggests that atorvastatin is effective in reducing inflammation, biochemical hyperandrogenemia, and metabolic parameters in patients with PCOS after a 12-wk period.

• Authors: Thozhukat Sathyapalan, Eric S Kilpatrick, Anne-Marie Coady, Stephen L Atkin
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 94 Issue 1 Pg. 103-8 (Jan 2009) ISSN: 0021-972X [Print] United States
• PMID: 18940877 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Cholesterol, LDL
• Heptanoic Acids
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Pyrroles
• Testosterone
• C-Reactive Protein
• Atorvastatin

Topics

• Adult
• Atorvastatin
• C-Reactive Protein (analysis)
• Cholesterol, LDL (blood)
• Double-Blind Method
• Female
• Heptanoic Acids (therapeutic use)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Insulin Resistance
• Polycystic Ovary Syndrome (blood, drug therapy)
• Pyrroles (therapeutic use)
• Testosterone (blood)