Primary and secondary prevention of metabolic and cardiovascular comorbidities in women with polycystic ovary syndrome

Abstract

Primary and secondary prevention of metabolic and cardiovascular comorbidities in women with polycystic ovary syndrome Prevenção primária e secundária de co-morbidades metabólicas e cardiovasculares em mulheres com síndrome do ovário policístico Poli Mara SPritzer 1 Current concepts on polycystic ovary syndrome Polycystic ovary syndrome (PCOS) is a very common endocrine disease, affecting women of reproductive age. The prevalence of PCOS varies according to the diagnostic criteria used, with estimates ranging from 9% in women of reproductive age according to NIH criteria up to 18% with Rotterdam criteria 1,2. Evidence indicates PCOS is a polygenic disease in which the individual susceptibility is also determined by environmental risk factors, including lifestyle. In essence, PCOS is characterized by androgen excess and chronic anovulation. However, the clinical presentation is heterogeneous among patients and may change in the same women along the years 2-4. Most common signs and symptoms include hirsutism, irregular menstrual cycles and infertility. In the last two decades it has become also clear that PCOS women often present insulin resistance and increased risk for metabolic syndrome, type 2 (T2) diabetes, dyslipidemia and hypertension. Currently, the diagnosis of PCOS is confirmed according the Rotterdam Consensus 5 , an expansion of the former NIH criteria 6. Proposed Rotterdam criteria for PCOS include two out of the following three: the presence of clinical and/or biochemical hyperandrogenism, oligomenorrhea/anovulation and the polycystic ovary appearance (PCO) on ultrasound. In turn, the Androgen Excess and PCOS Society 7 considers that androgen excess is a central event in the pathogenesis and development of PCOS and that this criterion should be present for the diagnosis of PCOS. In any case, other androgen excess disorders, such as non-classic congenital adrenal hyperplasia (NC-CAH), Cushing's syndrome, androgen secreting tumors, hyperprolactinemia, thyroid diseases, drug-induced androgen excess should be excluded as well as the other causes for oligomenorrhea or anovulation 5-7. Recently, the Expert Panel from a NIH Evidence Based Methodology Workshop on PCOS reinforced the use of the wider Rotterdam criteria 8. In consequence, new phenotypes had arisen in addition to the classic phenotype, in which patients present hyperandrogenism and oligomenorrhea with or without PCO on ultrasound. These new phenotypes are the