Apolipoprotein A-I and B levels, dyslipidemia and metabolic syndrome in south-west Chinese women with PCOS

Jinxia Zhang, Ping Fan, Hongwei Liu, Huai Bai, Ying Wang, Feng Zhang
Human Reproduction 2012, 27 (8): 2484-93

STUDY QUESTION: What are the relationships between apolipoprotein (apo) A-I and apoB concentrations, the apoB/apoA-I ratio and the prevalences of dyslipidemia and metabolic syndrome (MS) in south-west Chinese women with polycystic ovary syndrome (PCOS).

SUMMARY ANSWER: There is a relatively high incidence of dyslipidemia and MS in south-west Chinese women with PCOS, especially in patients without hyperandrogenism. Patients with dyslipidemia are more obese, and have a more adverse glucose and lipid metabolic profile and higher apoB levels and apoB/apoA-I ratio. The increased apoB levels and apoB/A1 ratio and the MS are strongly associated with PCOS, suggesting that there is an increased risk of cardiovascular diseases in these patients.

WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Dyslipidemia and MS have been widely studied in women with PCOS, but to date no data from south-west Chinese subjects have been available. The apoB/apoA-I ratio has been reported to be strongly associated with MS and insulin resistance (IR) and to be a reliable parameter that reflects lipid disturbances and the potential to develop atherosclerosis, but its relationship with PCOS is unclear. DESIGN This case-control study included 406 patients with PCOS and 342 control women between 17 and 40 years of age from a population in south-west China during 2006-2011.

PARTICIPANTS AND SETTING: The diagnosis of PCOS was based on the revised 2003 Rotterdam criteria. The control group, consisting of women with infertility due to a Fallopian obstruction or the husband's infertility, women undergoing a pre-pregnancy check and healthy volunteers, was recruited from the same hospital during the same period. All women were not taking any medication known to affect carbohydrate or lipid or hormone metabolism for at least 3 months prior to the study, and were studied during the follicular phase of their menstrual cycle. MS was assessed by the National Cholesterol Education Program-Adult treatment Panel (NCEP-ATP) III criteria modified for Asian populations. Dyslipidemia was defined by one or more of the following conditions: fasting total cholesterol≥5.7 mmol/l, fasting triglycerides (TG)≥1.7 mmol/l, fasting high-density lipoprotein cholesterol (HDL-C)<1.29 mmol/l or fasting low-density lipoprotein cholesterol (LDL-C)≥3.6 mmol/l.

MAIN RESULTS AND THE ROLE OF CHANCE: The prevalence of dyslipidemia in patients with PCOS was 52.96%, about two times than that in the controls, 28.95%. The most common components of dyslipidemia in patients with PCOS were decreased HDL-C (41.13%) and increased TG (24.14%). PCOS patients with dyslipidemia had significantly higher TG/HDL-C ratios, and lower HDL-C and apoA-I levels when compared with the controls or patients without dyslipidemia, and had significantly higher BMIs, fasting insulin concentrations, 2-h insulin and glucose levels, homeostatic model assessment IR, TG levels, LDL-C levels, atherogenic indexes, apoB concentrations and apoB/apoA-I ratios when compared with all of the control women, with or without dyslipidemia and patients without dyslipidemia. The frequency of MS in patients with PCOS was 25.62%, more than five times than that in the controls. The main two risk factors were increased waist circumference and low HDL-C levels. In the four PCOS phenotypes based on the Rotterdam criteria, the oligo- and/or anovulation+PCO presented the highest prevalence of dyslipidemia (66.14%) and MS (34.65%). Binary logistic regression analysis showed that increased apoB levels, an increased apoB/apoA-I ratio and MS was strongly associated with PCOS (odds ratio=17.41, 27.16 and 7.66, 95% confidence interval: 6.93-43.74, 9.46-77.93 and 4.32-13.57, respectively) after adjustment for age.

BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION: The relatively minor limitations of this study are discussed within the paper. GENERALISABILITY TO OTHER POPULATIONS: The metabolic patterns found in south-west Chinese with PCOS are compared with that of other populations.

STUDY FUNDING/COMPETING INTEREST(S): This work was supported by Chinese National Natural Science Foundation (81070463), Program for Changjiang Scholars and Innovative Research Team in University (IRT0935), and Research Seed Fund from West China Second Hospital of Sichuan University (to H.B.). There are no any competing interests.


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