title: How should we manage atherogenic dyslipidemia in women with polycystic ovary syndrome?
abstract: Despite their young age, women with polycystic ovary syndrome (PCOS) have increased cardiovascular risk. Besides normal concentrations of low-density lipoprotein (LDL) cholesterol, dyslipidemia is very common and includes elevated triglyceride levels and low high-density lipoprotein cholesterol concentrations. Recent findings also showed that women with PCOS have qualitative LDL alterations, with increased levels of atherogenic small, dense LDL particles. Such lipid abnormalities constitute a common form of dyslipidemia, the so-called atherogenic lipoprotein phenotype (ALP), associated with a greater cardiovascular risk. Weight reduction and increased physical activity may constitute first-line therapy for ALP in PCOS, and lipid lowering drugs, particularly nicotinic acid and fibrates, should be used in patients with severe dyslipidemia. Statins have usually a lower impact on ALP, and their beneficial effect is often moderate. Insulin-sensitizing medications favorably alter each component of ALP and combined therapy with these agents remains an option; in particular, the combination pioglitazone plus metformin seems to be particularly beneficial.
authors.affiliation: Department of Clinical Medicine and Emerging Diseases, University of Palermo, Palermo, Italy. mrizzo@unipa.it
authors.forename: Manfredi
authors.initials: M
authors.lastname: Rizzo
authors.forename: Kaspar
authors.initials: K
authors.lastname: Berneis
authors.forename: Enrico
authors.initials: E
authors.lastname: Carmina
authors.forename: Giovam Battista
authors.initials: GB
authors.lastname: Rini
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000188:drug therapy* / Q000209:etiology; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000187:drug effects / Q000378:metabolism; D008078:Cholesterol, LDL / Q000187:drug effects / Q000378:metabolism; D018849:Controlled Clinical Trials as Topic; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors