Dyslipidemia is one of the most common metabolic disorders seen in PCOS patients (up to 70% prevalence in a US PCOS population) (78). It is associated with insulin resistance and hyperandrogenism in combination with environmental (diet, physical exercise) and genetic factors. Various abnormal patterns include decreased levels of HDL, elevated levels of triglycerides, decreased total and LDL levels, and altered LDL quality (79,80).
To assess cardiovascular risks and prevent disease in patients with PCOS, the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society recommend the following monitoring activities (80): 1.
Waist circumference and BMI measurement at every visit, using the National Health and Nutrition Examination Survey method.
2.
A complete lipid profile based using the American Heart Association guidelines (Fig. 31.6). If the fasting serum lipid profile is normal, it should be reassessed every 2 years or sooner if weight gain occurs.
3.
A 2-hour post-75-g oral glucose challenge measurement in PCOS women with a BMI greater than 30 kg/m2, or alternatively in lean PCOS women with advanced age (40 years), personal history of gestational diabetes, or family history of type 2 diabetes.
4.
Blood pressure measurement at each visit. The ideal blood pressure is 120/80 or lower. Prehypertension should be treated because blood pressure control has the largest benefit in reducing cardiovascular diseases.
5.
Regular assessment for depression, anxiety, and quality of life.
130 100 70 160 130 100 LDL target values, mg/dL Non-HDL target values, mg/dL
PCOS PCOS with metabolic PCOS with metabolic syndrome syndrome and Type 2 diabetes mellitus, overt vascular and/or renal disease
Figure 31.6 Lipid guidelines in PCOS to prevent cardiovascular disease risk (values in mg/dL). (Non-HDL = Total Cholesterol − HDL, if TG <400 mg/dL). (Data for figure derived from Wild RA, Carmina E, Diamanti-Kandarakis E, 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 Endocrinol Metab 2010;95(5):2038–2049.)
A significant proportion of the population and particularly the obese population have inadequate vitamin D levels. Because vitamin D plays a role in many metabolic activities, assessment and supplementation when indicated are recommended.
Deficient: 8 ng/mL or less (≤20 nmol/L)
Insufficient: 8–20 ng/mL (20–50 nmol/L)
Optimal: 20–60 ng/mL (50–150 nmol/L; 40–50 ng/mL is treatment goal)
High: 60–90 ng/mL (150–225 nmol/L)
Toxic: >90 ng/mL or greater (≥225 nmol/L) 1.
The body uses 3,000 to 5,000 IU D3 per day.
2.
In the absence of the sun, 600 IU of D3 are required to maintain vitamin D levels.
3.
D2 is more rapidly metabolized and is less potent than D3.
4.
Patients receiving 50,000 IU of vitamin D2 once a week for 8 weeks will usually correct a vitamin D deficiency, and this can be followed by giving 50,000 U of vitamin D2 once every other week to maintain vitamin D sufficiency.