Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age, affecting around 10% of them. Polycystic ovary syndrome is considered to be related to increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). There are 2 definitions for PCOS: one adopted in 1990 (classical PCOS with phenotypes A and B) and the otherin 2003 (Rotterdam criteria with 4 phenotypes A to D). The latter is a wider definition including the 1990 phenotypes. There is mounting data suggesting that phenotypes C and D are not actually related to increased CVD risk, and thus screening for CVD risk factors of intervening for primary CVD prevention in young women is not cost-effective. There is an increasing number of suggestions to return to the 1990 criteria plus some metabolic parameters to identify real CVD risk in this population. However, such a strategy needs verification by large, prospective studies.
Knochenhauer ES, Key TJ, Kahsar-Miller M., Waggoner W., Boots LR, Azziz R.Prevalence of the polycystic ovary syndrome in unselected black and white women of the southern eastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83(9):3078-3082.
2.
Sheehan MTPolycystic ovarian syndrome: diagnosis and management. Clin Med Res. 2004;2(1):13-27.
3.
Stein IF, Leventhal MLAmenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29(4):181-191.
4.
Zawadski JK, Dunaif A.Diagnostic criteria for polycystic ovary syndrome: towards a rational approach . In: Dunaif A, Givens JR, Haseltine F, eds. Polycystic Ovary Syndrome. Boston, NY: Blackwell Scientific;1992:377-384.
5.
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):19-25.
6.
Azziz R., Marin C., Hoq L., Badamgarav E., Song P.Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab. 2005;90(8): 4650-4658.
7.
Azziz R.Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab . 2006;91(3):781-785.
8.
Azziz R., Carmina E., Dewailly D., et al. Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society Guideline . J Clin Endocrinol Metab. 2006;91(11):4237-4245.
9.
Broekmans FJ , Knauff EA, Valkenburg O., Laven JS, Eijkemans MJ, Fauser BCPCOS according to the Rotterdam consensus criteria: change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG. 2006;113(10):1210-1217.
10.
Amato MC, Galluzzo A., Finocchiaro S., Criscimanna A., Giordano C.The evaluation of metabolic parameters and insulin sensitivity for a more robust diagnosis of the polycystic ovary syndrome. Clin Endocrinol (Oxf). 2008;69(1):52-60.
11.
Zhang HY, Zhu FF, Xiong J., Shi XB, Fu SXCharacteristics of different phenotypes of polycystic ovary syndrome based on the Rotterdam criteria in a large-scale Chinese population. BJOG.2009;116(12):1633-1639.
12.
Carmina E., Rosato F., Jannì A., Rizzo M., Longo RAExtensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab. 2006;91(1):2-6.
Carmina E., Chu MC, Longo RA, Rini GB, Lobo RAPhenotypic variation in hyperandrogenic women influences the findings of abnormal metabolic and cardiovascular risk parameters. J Clin Endocrinol Metab. 2005;90(5):2545-2549.
15.
Rizzo M., Berneis K., Hersberger M., et al. Milder forms of atherogenic dyslipidemia in ovulatory versus anovulatory polycystic ovary syndrome phenotype. Hum Reprod.2009;24(9):2286-2292.
16.
Legro RS, Kunselman AR, Dunaif A.Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome . Am J Med. 2001;111(8):607-613.
17.
Cussons AJ, Stuckey BG, Watts GFCardiovascular disease in the polycystic ovary syndrome: new insights and perspectives. Atherosclerosis. 2006;185(2):227-239.
18.
National Cholesterol EducationProgram (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation . 2002; 106(25):3143-3421.
19.
Castelo-Branco C., Steinvarcel F., Osorio A., Ros C., Balasch J.Atherogenic metabolic profile in PCOS patients: role of obesity and hyperandrogenism. Gynecol Endocrinol. 2010;26(10): 736-742.
20.
Carmina E., Orio F., Palomba S., et al. Endothelial dysfunction in PCOS: role of obesity and adipose hormones. Am J Med. 2006; 119(4):356.e1-6.
21.
Fruzzetti F. , Perini D., Lazzarini V., Parrini D., Genazzani ARAdolescent girls with polycystic ovary syndrome showing different phenotypes have a different metabolic profile associated with increasing androgen levels. Fertil Steril.2009;92(2):626-634.
22.
Carmina E., Lobo RAPrevalence and metabolic characteristics of adrenal androgen excess in hyperandrogenic women with different phenotypes. J Endocrinol Invest. 2007;30(2):111-116.
23.
Wijeyaratne CN, Seneviratne RD, Dahanayake S., et al. Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): results of a large database from a specialist Endocrine Clinic. Hum Reprod.2011;26(1):202-213.
24.
Rizzo M., Longo RA, Guastella E., Rini GB, Carmina E.Assessing cardiovascular risk in mediterranean women with polycystic ovary syndrome. J Endocrinol Invest. 2010 Oct 15. [Epub ahead of print].
25.
Karkanaki A. , Piouka A., Katsikis I., Farmakiotis D., Macut D., Panidis D.Adiponectin levels reflect the different phenotypes of polycystic ovary syndrome: study in normal weight, normoinsulinemic patients . Fertil Steril.2009;92(6):2078-2081.
26.
Vryonidou A. , Papatheodorou A., Tavridou A., et al. Association of hyperandrogenemic and metabolic phenotype with carotid intimamedia thickness in young women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90(5):2740-2746.
27.
Berneis K., Rizzo M., Hersberger M., et al. Atherogenic forms of dyslipidaemia in women with polycystic ovary syndrome. Int J Clin Pract.2009;63(1):56-62.
28.
Rizzo M., Berneis K.An update on the role of the quality of LDL in cardiovascular risk: the contribution of the universities of Palermo and Zurich. Recent Pat Cardiovasc Drug Discov. 2007; 2(2):85-88.
29.
Berneis K., Rizzo M., Lazzarini V., Fruzzetti F., Carmina E.Atherogenic lipoprotein phenotype and low-density lipoproteins size and subclasses in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2007;92(1):186-189.
30.
Giallauria F., Orio F., Palomba S., Lombardi G., Colao A., Vigorito C.Cardiovascular risk in women with polycystic ovary syndrome. J Cardiovasc Med (Hagerstown ). 2008;9(10):987-992.
31.
Elting MW, Korsen TJ, Schoemaker J.Obesity, rather than menstrual cycle pattern or follicle cohort size, determines hyperinsulinaemia, dyslipidaemia and hypertension in ageing women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 2001;55(6): 767-776.
32.
Chun-Sen H. , Chien-Hua W., Wan-Chun C., Ching-Tzu L., Chun-Jen C., Ming-IH . Obesity and insulin resistance in women with polycystic ovary syndrome. Gynecol Endocrinol. 2010 May 26. [Epub ahead of print].
33.
Caballero AEEndothelial dysfunction in obesity and insulin resistance: a road to diabetes and heart disease. Obes Res . 2003; 11(11):1278-1289.
34.
Liou TH, Yang JH, Hsieh CH, Lee CY, Hsu CS, Hsu MIClinical and biochemical presentations of polycystic ovary syndrome among obese & nonobese women. Fertil Steril.2009;92(6): 1960-1965.
35.
Zhao X., Zhong J., Mo Y., Chen X., Chen Y., Yang D.Association of biochemical hyperandrogenism with type 2 diabetes and obesity in Chinese women with polycystic ovary syndrome. Int J Gynaecol Obstet.2010;108(2):148-151.
36.
Legro RS, Castracane VD, Kauffman RPDetecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls . Obstet Gynecol Surv. 2004;59(2):141-154.
37.
Schröder AK, Tauchert S., Ortmann O., Diedrich K., Weiss JMInsulin resistance in patients with polycystic ovary syndrome. Ann Med. 2004;36(6):426-439.
38.
Moran L., Teed H.Metabolic features of the reproductive phenotypes of polycystic ovary syndrome . Hum Reprod Update.2009; 15(4):477-488.
39.
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 Med. 2010;8:41.
40.
Prapas N., Karkanaki A., Prapas I., Kalogiannidis I., Katsikis I., Panidis D.Genetics of polycystic ovary syndrome. Hippokratia.2009;13(4):216-223.
41.
Balen AH, Conway GS, Kaltsas G., et al. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod. 1995;10(8):2107-2111.
42.
Kiddy DS, Sharp PS, White DM, et al. Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases. Clin Endocrinol (Oxf ). 1990;32(2):213-220.
43.
Shaw LJ, Bairey Merz CN, Azziz R., et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health-National Heart, Lung, and Blood Institute sponsored Women’s Ischemia Syndrome Evaluation. J Clin Endocrinol Metab. 2008; 93(3):1276-1284.
44.
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):165-169.
45.
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):141-146.
46.
Cussons AJ, Watts GF, Burke V., Shaw JE, Zimmet PZ, Stuckey BGCardiometabolic risk in polycystic ovary syndrome: a comparison of different approaches to defining the metabolic syndrome. Hum Reprod . 2008;23(10):2352-2358.
47.
Norman RJ, Masters L., Milner CR, Wang JX, Davies MJRelative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome . Hum Reprod. 2001;16(9):1995-1998.
48.
Economou F., Xyrafis X., Livadas S., et al. In overweight/obese but not in normal-weight women, polycystic ovary syndrome is associated with elevated liver enzymes compared to controls . Hormones . (Athens) 2009;8(3):199-206.
49.
Tan S., Bechmann LP, Benson S., et al. Apoptotic markers indicate nonalcoholic steatohepatitis in polycystic ovary syndrome. J Clin Endocrinol Metab.2010 ;95(1):343-348.
50.
Athyros VG, Mikhailidis DP, Didangelos TP, et al. Effect of multifactorial treatment on non-alcoholic fatty liver disease in metabolic syndrome: a randomised study. Curr Med Res Opin. 2006;22(5):873-883.
51.
Athyros VG, Tziomalos K., Gossios TD, et al. GREACE Study Collaborative Group. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis. Lancet.2010;376(9756):1916-1922.
52.
Kauffman RP , Baker TE, Baker V., Kauffman MM, Castracane VDEndocrine factors associated with non-alcoholic fatty liver disease in women with polycystic ovary syndrome: do androgens play a role?Gynecol Endocrinol. 2010;26(1): 39-46.
53.
Vacillator E., Lafoyianni S., Vryonidou A., et al. Increased androgen bioavailability is associated with non-alcoholic fatty liver disease in women with polycystic ovary syndrome. Hum Reprod.2010;25(1):212-220.
54.
Hossain N., Stepanova M., Afendy A., et al. Non-alcoholic steatohepatitis (NASH) in patients with polycystic ovarian syndrome (PCOS). Scand J Gastroenterol. 2010 Nov 30. [Epub ahead of print].
55.
Cakal E., Ustun Y., Engin-Ustun Y., Ozkaya M., Kilinç M.Serum vaspin and C-reactive protein levels in women with polycystic ovaries and polycystic ovary syndrome. Gynecol Endocrinol. 2010 Jul 13. [Epub ahead of print].
56.
Athyros VG, Kakafika AI, Karagiannis A., Mikhailidis DPDo we need to consider inflammatory markers when we treat atherosclerotic disease? Atherosclerosis. 2008;200(1):1-12.
57.
Escobar-Morreale HF, Luque-Ramírez M., González F.Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis. Fertil Steril. 2010 Dec 17. [Epub ahead of print].
58.
Makedos A., Goulis DG, Papanikolaou A., Panidis D.Serum high-sensitivity C-reactive protein and homocysteine changes during hormonal therapy in women with polycystic ovary syndrome: a prospective, matched study. Angiology.2010;61(6):595-601.
59.
Wild RA, Carmina E., Diamanti-Kandarakis E., et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab.2010;95(5):2038-2049.
60.
Florakis D. , Diamanti-Kandarakis E., Katsikis I., et al. Effect of hypocaloric diet plus sibutramine treatment on hormonal and metabolic features in overweight and obese women with polycystic ovary syndrome: a randomized, 24-week study. Int J Obes (Lond). 2008;32(4):692-699.
61.
Shroff R., Syrop CH, Davis W., Van Voorhis BJ, Dokras A.Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria. Fertil Steril. 2007;88(5):1389-1395.
