ABSTRACT

Aim:

Polycystic ovary syndrome (PCOS), one of the most common reproductive system disorders in women, is a clinical condition in which chronic inflammatory parameters increase. In this study, we aimed to evaluate the epicardial adipose tissue (EAT) thickness, inflammatory parameters and their relationships with each other by comparing PCOS patients and healthy controls.

Methods:

Serum complement 3 (C3) and complement 4 (C4) levels were evaluated and EAT was measured by transthoracic echocardiography.

Results:

Thirty-two patients with PCOS (mean age=24±6 years) and 27 healthy controls (mean age=26±3 years) were included in the study. EAT (p=0.000), abdominal subcutaneous thickness (p=0.000), C3 (p=0.023), C4 (p=0.039), hsCRP (p=0.026), GGT (p=0.012) and fibrinogen (p=0.035) levels were significantly increased in the PCOS group compared to the control group. It was found that EAT thickness was positively correlated with body mass index (BMI) (r=0.84, p=0.000), abdominal subcutaneous adipose tissue thickness (r=0.82, p=0.000), HOMA-IR (r=0.62, p=0.000), hsCRP (r=0.58, p=0.000), C3 (r=0.52, p=0.000), C4 (r=0.44, p=0.000), and fibrinogen (r=0.50, p=0.000) levels. In logistic regression analysis, Regardless of the BMI and abdominal subcutaneous thickness, EAT was found to have a significant relationship with PCOS. According to linear regression analysis; C4, HOMA-IR and hsCRP were found to have a significant relationship with EAT.

Conclusion:

Increased EAT, which was found to be significantly associated with PCOS, was showed to have a significant relationship with insulin resistance and C4 and hsCRP levels in this study. Clinically, the evaluation of the levels of inflammatory and immune parameters together with the measurement of EAT thickness in PCOS patients may be helpful in determining the cardiovascular risk. Prospective randomized controlled trials are needed to show this relationship more clearly.

References

1Franks S. Polycystic ovary syndrome. N Engl J Med 1995;333:853-61.

2Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19:41-7.

3Azziz R, Carmina E, Dewailly D, 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.

4Lorenz LB, Wild RA. Polycystic ovarian syndrome: an evidence-based approach to evaluation and management of diabetes and cardiovascular risks for today’s clinician. Clin Obstet Gynecol 2007;50:226-43.

5Tamakoshi K, Yatsuya H, Kondo T, et al. The metabolic syndrome is associated with elevated circulating C-reactive protein in healthy reference range, a systemic low-grade inflammatory state. Int J Obes Relat Metab Disord 2003;27:443-9.

6Tarkun I, Arslan BC, Canturk Z, Turemen E, Sahin T, Duman C. Endothelial dysfunction in young women with polycystic ovary syndrome: relationship with insulin resistance and low-grade chronic inflammation. J Clin Endocrinol Metab 2004;89:5592-6.

7Talbott EO, Guzick DS, Sutton-Tyrrell K, et al. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol 2000;20:2414-21.

8Burtis CA, Ashwood ER, Bruns DE, eds. TIETZ Textbook of Clinical Chemistry And Molecular Diagnostics. 4 ed; 2006.

9Buono C, Come CE, Witztum JL, et al. Influence of C3 deficiency on atherosclerosis. Circulation 2002;105:3025-31.

10Hollander W, Colombo MA, Kirkpatrick B, Paddock J. Soluble proteins in the human atherosclerotic plaque. With spectral reference to immunoglobulins, C3-complement component, alpha 1-antitrypsin and alpha 2-macroglobulin. Atherosclerosis 1979;34:391-405.

11Iacobellis G, Willens HJ. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 2009;22:1311-9;quiz 417-8.

12Rabkin SW. Epicardial fat: properties, function and relationship to obesity. Obes Rev 2007;8:253-61.

13Ehrmann 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;22:141-6.

14Bonora E, Kiechl S, Willeit J, et al. Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. Diabetes 1998;47:1643-9.

15Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-63.

16Wu Y, Zhang J, Wen Y, Wang H, Zhang M, Cianflone K. Increased acylation-stimulating protein, C-reactive protein, and lipid levels in young women with polycystic ovary syndrome. Fertil Steril 2009;91:213-9.

17Atiomo WU, Bates SA, Condon JE, Shaw S, West JH, Prentice AG. The plasminogen activator system in women with polycystic ovary syndrome. Fertil Steril 1998;69:236-41.

18Lee MY, Koh SB, Koh JH, et al. Relationship between gamma-glutamyltransferase and metabolic syndrome in a Korean population. Diabet Med 2008;25:469-75.

19Toscani M, Migliavacca R, Sisson de Castro JA, Spritzer PM. Estimation of truncal adiposity using waist circumference or the sum of trunk skinfolds: a pilot study for insulin resistance screening in hirsute patients with or without polycystic ovary syndrome. Metabolism 2007;56:992-7.

20Oksjoki R, Kovanen PT, Pentikainen MO. Role of complement activation in atherosclerosis. Curr Opin Lipidol 2003;14:477-82.

21Muscari A, Antonelli S, Bianchi G, et al. Serum C3 is a stronger inflammatory marker of insulin resistance than C-reactive protein, leukocyte count, and erythrocyte sedimentation rate: comparison study in an elderly population. Diabetes Care 2007;30:2362-8.

22Engstrom G, Hedblad B, Eriksson KF, Janzon L, Lindgarde F. Complement C3 is a risk factor for the development of diabetes: a population-based cohort study. Diabetes 2005;54:570-5.

23Wolbink GJ, Brouwer MC, Buysmann S, ten Berge IJ, Hack CE. CRP-mediated activation of complement in vivo: assessment by measuring circulating complement-C-reactive protein complexes. J Immunol 1996;157:473-9.

24Snyder ML, Shields KJ, Korytkowski MT, Sutton-Tyrrell K, Talbott EO. Complement protein C3 and coronary artery calcium in middle-aged women with polycystic ovary syndrome and controls. Gynecol Endocrinol 2014;30:511-5.

25Yang S, Li Q, Song Y, et al. Serum complement C3 has a stronger association with insulin resistance than high-sensitivity C-reactive protein in women with polycystic ovary syndrome. Fertil Steril 2011;95:1749-53.

26Dehdashtihaghighat S, Mehdizadehkashi A, Arbabi A, Pishgahroudsari M, Chaichian S. Assessment of C-reactive Protein and C3 as Inflammatory Markers of Insulin Resistance in Women with Polycystic Ovary Syndrome: A Case-Control Study. J Reprod Infertil 2013;14:197-201.

27Sahin SB, Cure MC, Ugurlu Y, et al. Epicardial adipose tissue thickness and NGAL levels in women with polycystic ovary syndrome. J Ovarian Res 2014;7:24.

28Arpaci D, Gurkan Tocoglu A, et al. The relationship between epicardial fat tissue thickness and visceral adipose tissue in lean patients with polycystic ovary syndrome. J Ovarian Res 2015;8:71.

29Durina J, Remkova A. Prothrombotic state in metabolic syndrome. Bratisl Lek Listy 2007;108:279-80.

Assesment of Inflammatory Markers and Epicardial Adipose Tissue Thickness in Women with Polycystic Ovary Syndrome

ABSTRACT

References