title: Obese adolescents with polycystic ovarian syndrome have elevated cardiovascular disease risk markers.
abstract: Women with polycystic ovarian syndrome (PCOS) have evidence of subclinical cardiovascular disease (CVD). However, insulin resistance, an important factor in the development of CVD in adults, is common in adolescents with PCOS, yet data in adolescents are limited. Therefore, we sought to measure insulin resistance and CVD markers in obese youth with and without PCOS. Thirty-six PCOS and 17 non-PCOS adolescent girls who were obese, sedentary, and non-hypertensive were recruited from clinics located within the Children's Hospital Colorado. Following 3 days of controlled diet and restricted exercise, fasting plasma samples were obtained prior to a hyperinsulinemic euglycemic clamp. PCOS girls were more insulin resistant than controls (glucose infusion rate 5.24±1.86 mg/kg/min vs 9.10±2.69; p<0.001). Girls with PCOS had blood pressure in the normal range, but had greater carotid intima-media thickness (cIMT) (0.49±0.07 mm vs 0.44±0.06; p=0.038), beta stiffness index (5.1±1.3 U vs 4.4±0.9; p=0.037), and reduced arterial compliance (1.95±0.47 mm2/mmHg × 10-1vs 2.13±0.43; p=0.047). PCOS girls had a normal mean lipid profile, yet had a more atherogenic lipoprotein cholesterol distribution and had persistent elevations of free fatty acids despite hyperinsulinemia (68±28 μmol/mL vs 41±10; p=0.001), both potential contributors to CVD. Free fatty acid concentrations correlated best with all CVD markers. In summary, adolescent girls with PCOS have greater cIMT and stiffer arteries than girls without PCOS, perhaps related to altered lipid metabolism, even when clinical measures of blood pressure and cholesterol profiles are 'normal'. Therefore, management of adolescent PCOS should include assessment of CVD risk factor development.
authors.affiliation: 1 Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Sonali S
authors.initials: SS
authors.lastname: Patel
authors.affiliation: 1 Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Uyen
authors.initials: U
authors.lastname: Truong
authors.affiliation: 2 Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Martina
authors.initials: M
authors.lastname: King
authors.affiliation: 2 Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Ferland
authors.affiliation: 3 Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.|4 Denver Veterans Administration Medical Center, Geriatric Research Education and Clinical Center, Denver, CO, USA.
authors.forename: Kerrie L
authors.initials: KL
authors.lastname: Moreau
authors.affiliation: 5 Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dorosz
authors.affiliation: 6 Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Hokanson
authors.affiliation: 6 Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: 6 Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Kinney
authors.affiliation: 7 Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: 2 Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Eckel
authors.affiliation: 7 Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.|8 Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.|9 Center for Women's Health Research, Aurora, CO, USA.
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Nadeau
authors.affiliation: 7 Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.|8 Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.|9 Center for Women's Health Research, Aurora, CO, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Cree-Green
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D002648:Child; D003120:Colorado; D005260:Female; D015309:Glucose Clamp Technique; D006776:Hospitals, Pediatric; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D063766:Pediatric Obesity / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D059289:Vascular Stiffness; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D018836:Inflammation Mediators; D007328:Insulin; D008055:Lipids
keywords: carotid intima–media thickness; cholesterol; obesity; pediatrics; polycystic ovarian syndrome; risk factors