title: Racial and ethnic differences in the polycystic ovary syndrome metabolic phenotype.
abstract: Women with polycystic ovarian syndrome have a high prevalence of metabolic syndrome and type 2 diabetes mellitus. Blacks and Hispanics have a high morbidity and mortality due to cardiovascular disease and diabetes mellitus in the general population. Since metabolic syndrome is a risk factor for development of type 2 diabetes and cardiovascular disease, understanding any racial and ethnic differences in metabolic syndrome among women with polycystic ovarian syndrome is important for prevention strategies. However, data regarding racial/ethnic differences in metabolic phenotype among women with polycystic ovary syndrome are inconsistent.
  
  
  
  We sought to determine if there are racial/ethnic differences in insulin resistance, metabolic syndrome, and hyperandrogenemia in women with polycystic ovarian syndrome.
  
  
  
  We conducted secondary data analysis of a prospective multicenter, double-blind controlled clinical trial, the Pregnancy in Polycystic Ovary Syndrome II study, conducted in 11 academic health centers. Data on 702 women with polycystic ovarian syndrome aged 18-40 years who met modified Rotterdam criteria for the syndrome and wished to conceive were included in the study. Women were grouped into racial/ethnic categories: non-Hispanic whites, non-Hispanic blacks, and Hispanic. The main outcomes were the prevalence of insulin resistance, metabolic syndrome, and hyperandrogenemia in the different racial/ethnic groups.
  
  
  
  Body mass index (35.1 ± 9.8 vs 35.7 ± 7.9 vs 36.4 ± 7.9 kg/m2) and waist circumference (106.5 ± 21.6 vs 104.9 ± 16.4 vs 108.7 ± 7.3 cm) did not differ significantly between non-Hispanic white, non-Hispanic black, and Hispanic women. Hispanic women with polycystic ovarian syndrome had a significantly higher prevalence of hirsutism (93.8% vs 86.8%), abnormal free androgen index (75.8% vs 56.5%), abnormal homeostasis model assessment (52.3% vs 38.4%), and hyperglycemia (14.8% vs 6.5%), as well as lower sex hormone binding globulin compared to non-Hispanic whites. Non-Hispanic black women had a significantly lower prevalence of metabolic syndrome (24.5% vs 42.2%) compared with Hispanic women, and lower serum triglyceride levels compared to both Hispanics and non-Hispanic whites (85.7 ± 37.3 vs 130.2 ± 57.0 vs 120.1 ± 60.5 mg/dL, P < .01), with a markedly lower prevalence of hypertriglyceridemia (5.1% vs 28.3% vs 30.5%, P < .01) compared to the other 2 groups.
  
  
  
  Hispanic women with polycystic ovarian syndrome have the most severe phenotype, both in terms of hyperandrogenism and metabolic criteria. Non-Hispanic black women have an overall milder polycystic ovarian syndrome phenotype than Hispanics and in some respects, than non-Hispanic white women.
authors.affiliation: Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT. Electronic address: lengmann@uchc.edu.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Engmann
authors.affiliation: Department of Biostatistics, Yale University School of Public Health, New Haven, CT.
authors.forename: Susan
authors.initials: S
authors.lastname: Jin
authors.affiliation: Department of Biostatistics, Yale University School of Public Health, New Haven, CT.
authors.forename: Fangbai
authors.initials: F
authors.lastname: Sun
authors.affiliation: Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Legro
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Polotsky
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK.
authors.forename: Karl R
authors.initials: KR
authors.lastname: Hansen
authors.affiliation: Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, PA.
authors.forename: Christos
authors.initials: C
authors.lastname: Coutifaris
authors.affiliation: Department of Obstetrics and Gynecology, Augusta University, Augusta, GA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Diamond
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
authors.forename: Esther
authors.initials: E
authors.lastname: Eisenberg
authors.affiliation: Department of Biostatistics, Yale University School of Public Health, New Haven, CT.
authors.forename: Heping
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Nanette
authors.initials: N
authors.lastname: Santoro
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D005260:Female; D006628:Hirsutism / Q000208:ethnology; D006801:Humans; D017588:Hyperandrogenism / Q000208:ethnology; D015228:Hypertriglyceridemia / Q000208:ethnology; D007333:Insulin Resistance / Q000208:ethnology; D024821:Metabolic Syndrome / Q000208:ethnology; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000208:ethnology*; D044469:Racial Groups; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D012738:Sex Hormone-Binding Globulin; D014280:Triglycerides
keywords: ethnicity; metabolism; phenotype; polycystic ovary syndrome; race; sex steroids