Polycystic Ovarian Syndrome: Metformin or Thiazolidinediones for Cardiovascular Risk Reduction?

Abstract

Objective. The purpose of this article is to explore the relationships among polycystic ovarian syndrome (PCOS), diabetes, and cardiovascular (CV) risk and review the use of metformin and thiazolidinediones (TZDs) in reducing CV risk in women with PCOS.Methods. The authors conducted a search for and reviewed reports of clinical trials, meta-analyses, and controlled trials published from January 1998 to December 2012 included in the PubMed, Cochrane Collaborative, and Health and Psychosocial Instruments databases. Search terms included PCOS, polycystic ovary/ovarian syndrome, diabetes mellitus, hyperglycemia, cardiovascular, metformin, TZDs, thiazolidinediones, rosiglitazone, and pioglitazone.Results. The articles provided evidence that PCOS is associated with both metabolic syndrome and diabetes in women. Metformin is an effective treatment for diabetes with favorable effects on lipid abnormalities to reduce CV risk. TZDs demonstrate some benefit on clinical markers associated with PCOS. However, there is no evidence that TZDs provide a greater benefit than metformin in reducing CV risk in women with PCOS and diabetes. Additionally, there is concern that TZDs may increase patients' risk of adverse events.Conclusions. Based on evidence linking PCOS to diabetes and increased CV risks, clinicians should systematically screen women with diabetes for PCOS and direct appropriate treatment at minimizing related risks. Treatment with metformin appears to be more beneficial than TZDs and has been shown to lower triglycerides, increase HDL cholesterol, and favorably influence serum insulin levels.