Ultrasonographic evaluation of intra-abdominal fat distribution and study of its influence on subclinical atherosclerosis in women with polycystic ovarian syndrome.

Objective: To evaluate abdominal fat distribution and cardiovascular disease (CVD) risk factors in women with polycystic ovarian syndrome (PCOS) and to determine the independent risk factors for subclinical atherosclerosis.

Methods: One hundred and twenty-four women with PCOS were compared with 118 age and BMI-matched controls. Abdominal obesity was assessed as the waist-to-hip ratio (WHR) and abdominal fat distribution was measured as subcutaneous fat thickness (SFT), pre-peritoneal fat thickness (PFT) and visceral fat thickness (VFT) using Ultrasound (US). Markers of subclinical atherosclerosis (carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilation (FMD)) and other CVD risk factors such as fasting glucose, fasting insulin (FIN), insulin resistance (HOMA-IR), androgens and lipid levels were measured.

Results: In comparison to controls, PCOS women had increased VFT and subclinical atherosclerosis. PCOS women also had higher FIN and lower levels of high-density lipoprotein cholesterol (HDL-C) and an elevated total cholesterol (TC) to HDL-C ratio. In PCOS women, VFT showed a strong association with CIMT and WHR showed a strong association with FIN and HOMA-IR; however these associations were weak in controls. Multiple regression analysis revealed VFT as the strongest independent predictor of CIMT in PCOS women whereas age was the only independent predictor of CIMT and FMD in controls.

Conclusions: While age can be an independent baseline risk factor for subclinical atherosclerosis in normal menstruating women, excess visceral fat accumulation is the most important predictor of atherosclerosis in PCOS patients.