title: Brachial-to-ankle pulse wave velocity as an independent prognostic factor for ovulatory response to clomiphene citrate in women with polycystic ovary syndrome.
abstract: BACKGROUND
  Polycystic ovary syndrome (PCOS) has a risk for cardiovascular disease. Increased arterial stiffness has been observed in women with PCOS. The purpose of the present study was to investigate whether the brachial-to-ankle pulse wave velocity (baPWV) is a prognostic factor for ovulatory response to clomiphene citrate (CC) in women with PCOS.
  
  
  METHODS
  This study was a retrospective cohort study of 62 women with PCOS conducted from January 2009 to December 2012 at the university hospital, Yamagata, Japan. We analyzed 62 infertile PCOS patients who received CC. Ovulation was induced by 100 mg CC for 5 days. CC non-responder was defined as failure to ovulate for at least 2 consecutive CC-treatment cycles. The endocrine, metabolic, and cardiovascular parameters between CC responder (38 patients) and non-responder (24 patients) groups were analyzed.
  
  
  RESULTS
  In univariate analysis, waist-to-hip ratio, level of free testosterone, percentages of patients with dyslipidemia, impaired glucose tolerance, and diabetes mellitus, blood glucose and insulin levels at 60 min and 120 min, the area under the curve of glucose and insulin after 75-g oral glucose intolerance test, and baPWV were significantly higher in CC non-responders compared with responders. In multivariate logistic regression analysis, both waist-to-hip ratio (odds ratio, 1.77; 95% confidence interval, 2.2-14.1; P=0.04) and baPWV (odds ratio, 1.71; 95% confidence interval, 1.1-2.8; P=0.03) were independent predictors of ovulation induction by CC in PCOS patients. The predictive values of waist-to-hip ratio and baPWV for the CC resistance in PCOS patients were determined by the receiver operating characteristic curves. The area under the curves for waist-to-hip ratio and baPWV were 0.76 and 0.77, respectively. Setting the threshold at 0.83 for waist-to-hip ratio offered the best compromise between specificity (0.65) and sensitivity (0.84), while the setting the threshold at 1,182 cm/s for baPWV offered the best compromise between specificity (0.80) and sensitivity (0.71).
  
  
  CONCLUSIONS
  Both metabolic and cardiovascular parameters were predictive for CC resistance in PCOS patients. The measurement of baPWV may be a useful tool to predict ovulation in PCOS patients who receive CC.
authors.affiliation: Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Igarashi
authors.affiliation: Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Hara
authors.affiliation: Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Amita
authors.affiliation: Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Hasegawa
authors.affiliation: Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kurachi
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002996:Clomiphene / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology*; D063177:Pulse Wave Analysis; D012372:ROC Curve; D012189:Retrospective Studies; D049629:Waist-Hip Ratio
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene
keywords: Brachial-to-ankle pulse wave velocity; Clomiphene citrate; Polycystic ovary syndrome; Waist-to-hip ratio