R E V I E W Cardiometabolic aspects of polycystic ovarian syndrome Li Wei Cho1 Harpal S Randeva2 Stephen L Atkin1 1Department of Medicine, University of Hull; 2Metabolic Unit, University Hospitals Coventry & Warwickshire NHS Trust, UK Correspondence: Li Wei Cho Michael White Centre for Diabetes and Endocrinology, Hull Royal Inﬁrmary, 220- 236 Anlaby Road, Hull, HU3 2RW, UK Tel +44 1482 675371 Fax +44 1482 675395 Email l.cho@hull.ac.uk Abstract: It is estimated that 6%–7% of women of reproductive age have polycystic ovarian syndrome (PCOS). Women with this condition exhibit an adverse cardiovascular risk proﬁle, characteristic of the cardiometabolic syndrome and given the high prevalence of PCOS in the female population, this condition may contribute towards the acceleration of cardiovascular disease among young women. This article summarizes the recent development and ﬁndings in the cardiometabolic abnormalities in patients with PCOS. Patients with PCOS have the clinical features of oligomenorrhoea, hirsutism and infertility; however, they also exhibit hyperinsu- linemia, obesity, hypertension, dyslipidemia, and an increased pro-thrombotic state. They have an increased risk of type 2 diabetes and impaired glucose tolerance, and sleep apnea is also found more commonly in this population. However, despite the presence of cardiovascular risk factors and increased surrogate markers of cardiovascular disease it is unclear if they have accelerated atherosclerosis. End point studies are currently lacking and the available evidence are conﬂicting. Adipose tissue has emerged as an important endocrine organ over the last decade and gained recognition in having an important role in the cardiometabolic syndrome. Adiponectin that is secreted exclusively by adipocytes has recently been recognized as an important marker of cardiometabolic syndrome, obesity, type 2 diabetes, and coronary artery disease. Other adipo- cytokines like leptin and resistin have also recently been recognized. This article will address the current evidence for the adverse cardiovascular risk in PCOS and the other factors that may be implicated. Finally the therapeutic options for treatment will be discussed. Keywords: cardiometabolic syndrome, polycystic ovarian syndrome, cardiovascular disease Introduction Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting 6%–7% of the population (Knochenhauer et al 1998; Diamanti-Kandarakis et al 1999; Asuncion et al 2000; Azziz et al 2004). It is characterized by chronic anovulation and hyperandrogenism with the clinical manifestation of oligomenorrhoea, hirsut- ism, and acne (Franks 1995). In January 2004, the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) co-sponsored the Rotterdam polycystic ovary syndrome consensus workshop that published diagnostic guidelines, building on the consensus statement of the National Institutes of Health 1990 (ESHRE/ASRM-Sponsored_PCOS_Con- sensus_Workshop_Group 2004). The Rotterdam criteria for the diagnosis of PCOS states 2 of the 3 features needs to be present to make the diagnosis and with the exclu- sion of other etiologies (congenital adrenal hyperplasia, androgen-secreting tumors, Cushing’s syndrome). These features includes (1) Oligo- or anovulation (2) Clinical and/or biochemical signs of hyperandrogenism and (3) Polycystic ovaries (either 12 or more follicles measuring 2–9 mm in diameter, or an ovarian volume of >10 cm3) (Balen et al 2003). Vascular Health and Risk Management 2007:3(1) 55–63 © 2007 Dove Medical Press Limited. All rights reserved 55