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Journal of Medical Biochemistry

The Journal of Society of Medical Biochemists of Serbia

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Volume 36, Issue 3


Women with Polycystic Ovary Syndrome and Risk of Cardiovascular Disease

Iva Perovic Blagojevic
  • Corresponding author
  • Department of Laboratory Diagnostic, Clinical Hospital Center »Dr Dragisa Misovic – Dedinje«, Belgrade, Serbia
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/ Tatjana Eror
  • Clinic of Internal Medicine, Clinical Hospital Center »Dr Dragisa Misovic – Dedinje«, Belgrade, Serbia
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/ Jovana Pelivanovic
  • Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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/ Svetlana Jelic / Jelena Kotur-Stevuljevic
  • Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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/ Svetlana Ignjatovic
  • Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
  • Center for Medical Biochemistry, Clinical Center Serbia, Belgrade, Serbia
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  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-07-14 | DOI: https://doi.org/10.1515/jomb-2017-0020


Background: Polycystic ovary syndrome (PCOS) is associated with reproductive and metabolic abnormalities. The aim of this study was to analyse risk of cardiovascular disease (CVD) in PCOS, to define individual risk factors and assess their ability to predict risk.

Methods: Fifty-four young women with PCOS (22 obese and 32 normal weight) were compared to 46 respective controls (17 obese and 29 normal weight). Anthropometric parameters, lipid status parameters, inflammation markers, concentrations of glucose, transaminases, sex and anterior pituitary hormones, sex hormone binding globulin (SHBG) and androgens were measured. Cardiovascular Risk Score (CVRS), indices for identifying Non-Alcoholic Fatty Liver Disease (NAFLD) and the Index of Central Obesity (ICO) were calculated.

Results: Significantly higher CVRS values (p<0.05) were found in obese PCOS women compared to normal weight control and normal weight PCOS groups. Anthropometric parameters, lipid status parameters and fibrinogen (p<0.001, p<0.01) were higher in women with higher CVRS. The most significant CVRS predictors in all PCOS women were SHBG, androstenedione, follicle-stimulating hormone (FSH) and dehydroepiandrosterone sulphate (DHEAS). ICO and all NAFLD indices exhibited significant positive correlation with CVRS and a model consisting of these indices provided good diagnostic accuracy (AUC>0.8) in identifying patients with increased cardiovascular risk (CVR).

Conclusions: Obesity is a higher risk for developing CVD than PCOS alone. Anthropometric parameters, lipid parameters, fibrinogen, NAFLD indices and ICO increase CVR in PCOS women. For the prediction of CVR in PCOS, we suggest a combination of NAFLD indices and ICO.

Keywords: polycystic ovary syndrome; cardiovascular disease; cardiovascular risk score; non-alcoholic fatty liver disease; central obesity index


  • 1. Goodarzi M, Carmina E, Azziz R. DHEA, DHEAS and PCOS. J Ster Bioch 2015; 145: 213–25.Google Scholar

  • 2. World Health Organisation, Global Health Observatory data, Mortality and morbidity, Cardiovascular diseases [04.09.2016.], http://www.who.int/gho/ncd/mortality_morbidity/cvd/en/.

  • 3. Birdsall MA, Farquhar CM, White HD. Association between polycystic ovaries and extent of coronary artery disease in women having cardiac catheterization. Ann Intern Med 1997; 126: 32–5.Google Scholar

  • 4. Legro RS. Polycystic Ovary Syndrome and Cardiovascular Disease: A Premature Association? End Rev 2003; 24: 302–12.CrossrefGoogle Scholar

  • 5. Temple R. Are surrogate markers adequate to assess cardiovascular disease drugs? JAMA 1999; 282: 790–5.Google Scholar

  • 6. Dokras A. Cardiovascular disease risk in women with PCOS. Steroids 2013; 78: 773–6.Web of ScienceGoogle Scholar

  • 7. Lonardo A, Sookoian S, Pirola CJ, Targher G. Non-alcoholic fatty liver disease and risk of cardiovascular disease. Metabolism 2015; 65: 1136–50.Web of ScienceGoogle Scholar

  • 8. Cerda C, Pérez-Ayuso RM, Riquelme A, Soza A, Villaseca P, Sir-Petermann T, et al. Non-alcoholic fatty liver disease in women with polycystic ovary syndrome. J Hepatology 2007; 47: 412–7.Google Scholar

  • 9. Xiang S, Hua F, Chen L, Tang Y, Jiang X, Liu Z. Lipid Accumulation Product is Related to Metabolic Syndrome in Women with Polycystic Ovary Syndrome. Exp Clin End Diab 2013; 121: 115–8.Google Scholar

  • 10. Sert A, Pirgon O, Aypar E, Yilmaz H, Dündar B. Relationship between aspartate aminotransferase-to-platelet ratio index and carotid intima-media thickness in obese adolescents with non-alcoholic fatty liver disease. J Clin Res Ped End 2013; 5: 182–8.Google Scholar

  • 11. Lee JH, Kim D, Kim HJ, Lee CH, Yang JI, Kim W, et al. Hepatic steatosis index: A simple screening tool reflecting non-alcoholic fatty liver disease. Dig Liver Dis 2010; 42: 503–8.Google Scholar

  • 12. Parikh RM, Joshi SR, Menon PS, Shah NS. Index of central obesity – A novel parameter. Med Hypotheses 2007; 68: 1272–5.Web of ScienceGoogle Scholar

  • 13. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004 Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19: 41–7.Google Scholar

  • 14. Warnick GR, Knopp RH, Fitzpatrick V, Branson L. Estimating low-density lipoprotein cholesterol by the Friede-wald equation is adequate for classifying patients on the basis of nationally recommended cutpoints. Clin Chem 1990; 36: 15–9.Google Scholar

  • 15. McMahan CA, Gidding SS, Fayad ZA, Zieske AW, Malcom GT, Tracy RE, et al. Risk scores predict atherosclerotic lesions in young people. Arch Intern Med 2005; 165: 883–90.Google Scholar

  • 16. Pasquali R, Zanotti L, Fanelli F, Mezzullo M, Fazzini A, Morselli Labate AM, et al. Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective. J Clin End Met 2016; 101: 2013–22.Google Scholar

  • 17. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91: 456–88.Web of ScienceCrossrefGoogle Scholar

  • 18. Wiegman A, Hutten BA, de Groot E, Rodenburg J, Bakker HD, Büller HR, et al. Efficacy and safety of statin therapy in children with familial hypercholesterolemia: a randomized controlled trial. JAMA 2004; 292: 331–7.Google Scholar

  • 19. Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis: a report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Arterioscler Thromb Vasc Biol 1995; 15: 1512–31.CrossrefGoogle Scholar

  • 20. Orio F Jr, Palomba S, Spinelli L, Cascella T, Tauchmanovà L, Zullo F, et al. The Cardiovascular Risk of Young Women with Polycystic Ovary Syndrome: An Observational, Analytical, Prospective Case-Control Study. J Clin End Met 2003; 89: 3696–701.Google Scholar

  • 21. Bickerton AS, Clark N, Meeking D, Shaw KM, Crook M, Lumb P, et al. Cardiovascular risk in women with polycystic ovarian syndrome (PCOS). J Clin Pathol 2005; 58: 151–4.Google Scholar

  • 22. Elting MW, Korsen TJ, Bezemer PD, Schoemaker J. Prevalence of diabetes mellitus, hypertension and cardiac complaints in a follow-up study of a Dutch PCOS population. Hum Reprod 2001; 16: 556–60.CrossrefGoogle Scholar

  • 23. Chen MJ, Yang WS, Yang JH, Chen CL, Ho HN, Yang YS. Relationship between androgen levels and blood pressure in young women with polycystic ovary syndrome. Hypertension 2007; 49: 1442–7.Web of ScienceGoogle Scholar

  • 24. Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, 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 End Met 2010; 95: 2038–49.Google Scholar

  • 25. Conway GS, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, et al. The Polycystic Ovary Syndrome: an Endocrinological Perspective from the European Society of Endocrinology. Eur J End 2014; 171: 489–98.Google Scholar

  • 26. Macut D, Bjekic-Macut J, Savic-Radojevic A. Dyslipidemia and oxidative stress in PCOS. Front Horm Res 2013; 40: 51–63.Google Scholar

  • 27. Macut D, Damjanovic S, Panidis D, Spanos N, Glisic B, Petakov M, et al. Oxidised low-density lipoprotein concentration – early marker of an altered lipid metabolism in young women with PCOS. Eur J End 2006; 155: 131–6.Google Scholar

  • 28. Wild RA, Rizzo M, Clifton S, Carmina E. Lipid levels in polycystic ovary syndrome: systematic review and meta analysis. Fertil Steril 2011; 95: 1073–9.Web of ScienceGoogle Scholar

  • 29. Skafar DF, Xu R, Morales J, Ram J, Sowers JR. Female sex hormones and cardiovascular disease in women. J Clin End Met 1997; 82: 3913–8.Google Scholar

  • 30. Mendelsohn ME, Karas RH. The Progective Effects of Estrogen on the Cardiovascular System. The New Engl J Med 1999; 340: 1801–11.Google Scholar

  • 31. Chu MC, Rath KM, Huie J, Taylor HS. Elevated basal FSH in normal cycling women is associated with unfavourable lipid levels and increased cardiovascular risk. Hum Repr 2003; 18: 1570–3.CrossrefGoogle Scholar

  • 32. Carmina E, Lobo RA. Prevalence and metabolic characteristics of adrenal androgen excess in hyperandrogenic women with different phenotype. J End Invest 2007; 30: 111–6.CrossrefGoogle Scholar

  • 33. Schaffrath G, Kische H, Gross S, Wallaschofski H, Völzke H, Dörr M, et al. Association of sex hormones with incident 10-year cardiovascular disease and mortality in women. Maturitas 2015; 82: 424–30.Web of ScienceGoogle Scholar

  • 34. Wiltgen D, Benedetto IG, Mastella LS, Spritzer PM. Lipid accumulation product index: a reliable marker of cardiovascular risk in polycystic ovary syndrome. Hum Repr 2009; 24: 1726–31.CrossrefGoogle Scholar

  • 35. Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto P, Orio F, et al. Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. JCEM 2007; 92: 2500–5.Google Scholar

  • 36. Monami M, Bardini G, Lammana C, Pala L, Cresci B, Francesconi P, et al. Liver enzymes and risk of diabetes and cardiovascular disease: Results of the Firenze Bagno a Ripoli (FIBAR) study. Metabolism 2008; 57: 387–92.Web of ScienceGoogle Scholar

About the article

Received: 2017-03-26

Accepted: 2017-04-02

Published Online: 2017-07-14

Published in Print: 2017-09-01

Citation Information: Journal of Medical Biochemistry, Volume 36, Issue 3, Pages 259–269, ISSN (Online) 1452-8266, DOI: https://doi.org/10.1515/jomb-2017-0020.

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© 2017 Iva Perovic Blagojevic et al., published by De Gruyter Open. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

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