Cover
Vol. 1 No. 2 (2011)

Published: December 31, 2011

Pages: 13-17

Research Article

Effects of metformin on the lipid profile in polycystic ovarian syndrome patients

Tariq N. Musa 1 Qais Ahmed Ibraheem 2 Manal Taha Al-Obaidy 1
1Basic Science, Agriculture College, Baghdad University, Baghdad, Iraq
2Institute of Embryo Research and Infertility Treatment, Al-Nahrain University, Baghdad, Iraq
History
  • Received: September 1, 2011
  • Available Online: December 1, 2011

Abstract

Background: Polycystic ovary syndrome (PCOS) is the most common and prevalent endocrinopathy in women, and the most common cause of anovulatory infertility. An altered lipid profile is common in polycystic ovary syndrome (PCOS) and is usually characterized by increased total cholesterol, triglycerides, low-density lipoproteins and very low density lipoprotein levels with low high-density lipoprotein. PCOS is associated with a higher frequency of cardiovascular disease because of dyslipidemia. Which are potent markers for cardiovascular risk factors. Metformin, is a widely used antihyperglycemic agent. It decreases insulin resistance and reduces hyperglycemia through a reduction of the hepatic glucose production. Objectives: Determine the beneficial effect of metformin in PCOS patients in reducing lipid profile and subsequently reduction in cardiovascular disease. Method: Measurements and analysis levels of total cholesterol, triglycerides, low-density lipoproteins, very low density lipoprotein and high-density lipoprotein were samples collected at the Institute of embryo research and infertility treatment, Al-Nahrain University. PCOS patients were recruited at the consultant clinic Patients: forty three women with PCOS were studied. Anthropometric data, lipid profile, were evaluated, before oral metformin (500mg/twice daily) treatment and after three months of use. Results: Patients with PCOS after oral metformin treatment, revealed a significant lowering serum concentrations of total cholesterol, triglyceride, low-density lipoproteins and very low density lipoprotein and elevated high-density lipoprotein compared to before treatment. Conclusions: dyslipidemia is common finding in PCOS women, in this study we found that the use of oral metformin tablets 500mg/twice daily for three months will correct lipid profile level (cholesterol, triglyceride, LDL, VLDL and HDL) which is considered as cardiovascular risk factors and this lead to reduce risk of cardiovascular diseases.

Keywords

References

  1. Homburg R. Polycystic ovary syndrome-from gynaecological curiosity to multisystem endocrinopathy. Hum Reprod. 1996; 11:29-39.
  2. Scarpitta AM and Sinagra D. Polycystic ovary syndrome: an endocrine and metabolic disease. Gynecol Endocrinol. 2000; 14:392-395.
  3. Leo V D, Marca Aland Petraglia F. Insulin-Lowering Agents in the Management of Polycystic Ovary Syndrome. Endocrine Society. 2003; 5:633-667.
  4. Wang JX, Davies MJ and Norman RJ. Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment. Hum Reprod. 2001;16:2606-2609.
  5. Balen Aand Michelmore K.What is polycystic ovary syndrome Are national views important Hum Reprod. 2002; 17: 2219-2227.
  6. Elting MW, Korsen TJM, Rekers-Mombarg LTM and Schoemaker J. Women with polycystic ovary syndrome gain regular menstrual cycles when ageing. Hum Reprod. 2000; 15: 24-28.
  7. Kalro BN, Loucks TL, Berga SL. Neuromodulation in polycystic ovary syndrome. Obstet Gynecol Clin NorthAm. 2001; 28:35-62.
  8. Wild RA. Long-term health consequences of PCOS. Hum Reprod Update. 2002;8:231-241.
  9. Ovalle F and Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. FertilSteril. 2002; 77: 1095-1105.
  10. Christian RC, Dumesic DA, Behrenbeck T, Oberg AL, Sheedy IIPF and Fitzpatrick LA. Prevalence and predictors of coronary artery disease calcification in women with polycystic ovary syndrome.J Clin Endocrinol Metab. 2003;88:2562-2568.
  11. Wild RA. Polycystic ovary syndrome: a riskfor coronary artery disease Am.J. Obstet. Gynecol. 2002; 186:35-43.
  12. Balen A.The pathophysiology of polycystic ovary syndrome: trying to understand PCOS and its endocrinology. Best Pract Res Clin Obstet Gynaecol.2004; 18:685-706.
  13. Utiger RD. Insulin and the polycystic ovary syndrome. New Engl J Med. 1996; 335:657-658.
  14. Bailey CJ and Tumer RC. Metformin.. N Engl J Med. 1996; 334:574-579.
  15. Vrbikova Jand Cibula D. Combined oral contraceptives in the treatment of polycystic ovary syndrome. Hum Reprod Update. 2005;11:277-291.
  16. Tariq N, Ayub R, Alam AY, Rahim F and Raees SR. Clinical diagnosis of polycystic ovarian syndrome and response to metformin therapy. J Coll Physicians Surg Pak. 2007; 8: 469-72.
  17. Vause TD, Cheung AP, Sierra S, Claman P, Graham J, Guillemin JA, Lapensée L, Steward S andWong BC.Ovulation induction in polycystic ovary syndrome. J Obstet Gynaecol Can.2010;5:495-502.
  18. Tso LO, CostelloMF, Albuquerque LE, AndrioloRBand Freitas V. Metformin treatment before and during IVF or ICSI in women with polycysticovary syndrome. Cochrane Database Syst Rev. 2009; 15: (2)96-105.
  19. Homburg R. Should patients with polycystic ovary syndrome be treated with metformin. Hum Reprod. 2002; 17:853-865.
  20. Lo JC, Feigenbaum SL, Yang J, Pressman AR and Selby JV. Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91:1357-1363.
  21. Barter PJ, BrewerHB, Chapman MJ, Hennekens CH, Rader DJ and TallAR. Cholesterylester transfer protein: a novel target for raising HDL and inhibiting atherosclerosis. Arterioscler Thromb Vasc Biol. 2003; 23:160-167.
  22. Brunzell JD and Ayyobi AF. Dyslipidemia in the metabolic syndrome and type 2 diabetes mellitus.Am J Med. 2003; 115: 24S-28S.
  23. Londos C, Brasaemle DL, Schultz CJ, Adler-Wailes DC, Levin DM, KimmelAR and Rondinone CM. On the control of lipolysis in adipocytes. Annals of the New York Academy of Sciences. 1999:892: 155-168.
  24. Sztalryd C, Xu G, Dorward H, Tansey JT, Contreras JA, Kimmel AR and Londos C. Perilipin A is essential for the translocation of hormone-sensitive lipase during lipolytic activation.J CellBiol. 2003; 161:1093-1103.
  25. Tingting Zh, Jinhan He, Chong Xu, Luxia Zu, Hongfeng Ji, Shenshen Pu, Xiaohui Gu and Guoheng Xu. Mechanisms of metformin inhibiting lipolytic response to isoproterenol in primary rat adipocytes, Joumal of Molecular Endocrinology. 2009;42:57-66
  26. Virtanen K A, H?llsten K, Parkkola R, Janatuinen T, L?nnqvist F, Viljanen T, R?nnemaa T, Knuuti J, Huupponen R, L?nnroth P and Nuutila P. Differential Effects of Rosiglitazone and Metformin on Adipose Tissue Distribution and Glucose Uptake in Type 2 Diabetic Subjects. Diabetes. 2003;52: (2)283-290
  27. Hundal RS, Krssak M. Dufour S, Laurent D, Lebon V. ChandramouliV, Inzucchi SE, Schumann WC, Petersen KF and Landau BR. Mechanism by which metformin reduces glucose production in type 2 diabetes. Diabetes. 2000; 49: 2063-2069.
  28. Matthaei S, Stumvoli M, Kellerer M and Haring HU. Pathophysioogy and pharmacological treatment of insulin resistance. Endocr Rev.2000;21:585-618
  29. Murray RK, Granner DK, Mayes PA and Rodwell VW. Overview of Metabolism in: Mayes PA, and Bender DA. Editors. Harper's Illustrated Biochemistry. 26th(ed). Lange Medical Books/McGraw-Hill. NewYork, London, Mexico City. 2003; Pp125.
  30. Fulgencio JP, Kohl C, Girard J and Pegorier JP. Effect of metformin on fatty acid and glucose metabolism in freshly isolated hepatocytes and on specific gene expression in cultured hepatocytes. Biochem Pharmacol. 2001; 62: 439-446
  31. Carlsen SM, Rossvoll O, Bjerve KS and Folling I. Metformin improves blood lipid pattern in nondiabetic patients with coronary heart disease. Joumal of Intemal Medicine. 1996; 239:227-233.
  32. Dunn CJ and Peters DH. Metformin: a review of its pharmacological properties and therapeutic uses in noninsulin dependentdiabetes. Drugs. 1995;49:721-749.
  33. Lovejoy JC, Bray GA and Bourgeois MO. Exogenous androgens influence body composition and regional body fat distribution in obese postmenopausal women-a clinical research center study. J Clin Endocrinol Metab. 1996; 81: 2198-2203.
  34. Elbers JM, Giltay EJ, Teerlink T, Scheffer PG, Asscheman H, Seidell JC and Gooren LJ. Effects of sex steroids on componentsof the insulin resistance syndrome in transsexual subjects. Clin Endocrinol (Oxf). 2003;58:562-571
  35. De LV, La MA and Petraglia F. Insulin-lowering agents in the management of polycystic ovary syndrome. Endocr Rev. 2003; 24: 633-667.
  36. Azziz R, Ehrman D, Legro RS, Fereshetian AG, O'Keefe M and Ghazzi MN. Troglitazone decreases adrenal androgen levels in woman with polycystic ovary syndrome. Fertil Steril. 2003:79:932-937.
  37. Baillargeon JP, Jakubowicz DJ, Iuomo MJ, Jakubowicz S and Nestler JE. Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic syndrome and normal indices of insulin sensitivity. Fertil Steril. 2004;82:893-902.
  38. Chen M, YangW, Yang J, Hsiao C, Yang Y and Ho H. Low sex hormone-binding globulin is associated with low high-density lipoprotein cholesterol and metabolic syndrome in women with PCOS. Hum Reprod. 2006; 21: (9) 2266-2271
  39. Korytkowski MT, Krug El, Daly MA, Deriso L, Wilson JW, Winters SJ. Does androgen excess contribute to the cardiovascular risk profile in postmenopausalwomen with type 2diabetes Metabolism.2005;54:1626-1631.
  40. Bataille V, Perret B, Evans A, Amouyel P, Arveiler D, Ducimetiere P, Bard JM, Feieres J. Sex hormone-binding globulin is a major determinant of the lipid profile: the PRIME study.Atherosclerosis. 2005; 179:369-373.
  41. Valkenburg O, Steegers-Theunissen RP, SmedtsH, DallingaThie GM, Fauser BC, Westerveld E H and Laven JS. A more atherogenic serum lipoprotein profile is present in women with polycystic ovary syndrome: A case-control study. J Clin Endocrinol Metab. 2008;93:(2)470-476
  42. Legro RS. Polycystic ovary syndrome and cardiovascular disease: a premature association. Endocr Rev. 2003; 24:302-312.
  43. Rautio K, Tapanainen JS, Ruokonen A and Morin-Papunen LC. Effects of metformin and ethinyl estradiol-cyproterone acetate on lipid levels in obese and nonobese women with polycystic ovary syndrome. Eur J Endocrinol. 2005; 152: (2) 269-275.