Summary:
Background : Current knowledge on the pathophysiology of polycystic ovary
syndrome (PCOS) has created a new framework for the treatment of the syndrome,
which includes the need for amelioration of atherogenic markers which may be
elevated in women with the syndrome. The costs and benefits of two most
commonly prescribed pharmaceutical treatments in PCOS, oral contraceptives
(OCPs) and metformin have been studied in this framework. Metformin appears to
alleviate the cardiovascular risk associated with PCOS, while OCPs may have a
neutral or aggravating effect on atherogenic markers.
Objective: The present work compares the effects of two types of OCPs and
metformin on atherogenic markers, including serum levels of Advanced Glycated
End products (AGEs) and C-reactive protein (CRP), in lean women with PCOS.
Design: Prospective open-label study
Results: One hundred and twenty women with PCOS were treated for six months
with one of the following treatments: ethinylestradiol plus cyproterone acetate
(OCP 1) or ethinylestradiol plus drospirenone (OCP2) or metformin (MET). The
three groups were matched for age and body mass index (BMI). At six months
serum AGEs were decreased in all groups, but the decrease was greater with
metformin. Treatment with metformin was associated with a greater percent
decrease of AGEs. CRP was decreased with metformin, but increased with OCPs, to
a greater degree with OCP1 compared to OCP2.
Conclusions: This study attempts to evaluate common therapeutic options in
women with PCOS by reconsidering and prioritizing the goals of treatment. OCPs
and metformin appear to have differential effects on atherogenic molecules in
lean PCOS patients, but metformin was superior in reducing serum AGEs and CRP.
Clinicians should individualise the benefit-to-risk ratio of pharmaceutical
intervention in women with PCOS, in order to choose the formulation with the
greatest efficacy and safety in terms of cardiovascular risk.
Keywords:
Polycystic ovary syndrome, Cardiovascular risk markers, Advanced glycated end products, Oracl contraceptives, Metformin
