How should we manage atherogenic dyslipidemia in women with polycystic ovary syndrome?
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.
Rizzo
Manfredi
M
Department of Clinical Medicine and Emerging Diseases, University of Palermo, Palermo, Italy. mrizzo@unipa.it
Berneis
Kaspar
K
Carmina
Enrico
E
Rini
Giovam Battista
GB
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
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors