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Markers for Subclinical Atherosclerosis in Women with Polycystic Ovary Syndrome and Controls

Meyer, Michelle (2011) Markers for Subclinical Atherosclerosis in Women with Polycystic Ovary Syndrome and Controls. Doctoral Dissertation, University of Pittsburgh.

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    Abstract

    Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder among women in the United States. Women with PCOS experience acne, excessive hair, weight gain and irregular periods. Unfortunately, these women also have cardiovascular disease (CVD) risk factors including obesity, inflammation and type 2 diabetes. It is challenging to determine when and if atherosclerosis is accelerated in women with PCOS compared to controls as many studies investigate subclinical atherosclerosis in young women and are limited by small sample sizes. The purpose of this dissertation is to investigate markers for subclinical atherosclerosis in women with PCOS and non-PCOS controls.The meta-analysis on carotid intima-media thickness (CIMT) showed that women with PCOS have greater CIMT compared to controls. The summary estimates of the difference are comparable to a seven year progression in CIMT. This analysis also revealed CIMT estimates were more constant across studies with higher quality assessments of CIMT. The investigation of serum complement protein C3 (C3) suggested C3 may be an inflammatory risk marker for CVD in women with PCOS and controls. C3 was associated with traditional CVD risk factors in women with PCOS and controls, and was associated with coronary artery calcium (CAC) after adjusting for case control status, age, and either insulin or BMI. In the fully adjusted model with African American race, C3 was significantly associated with the presence of CAC.The trajectory analysis of flow-mediated dilation in women with PCOS and controls identified three patterns of change in lumen diameter that were labeled as non-dilators, dilators and enhanced dilators. Baseline lumen diameter, insulin and HDLc were associated with group membership, and an interactive effect between PCOS status and total cholesterol on group membership was detected. The findings from this dissertation clarify the mechanisms of subclinical atherosclerosis in women with PCOS and controls. This is of public health importance because many women with PCOS may not realize they are at risk for CVD. It is critical to evaluate factors that put these women at an increased risk of CVD so researchers can monitor risk factors and develop interventions to prevent atherosclerosis in this high risk population.


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    Item Type: University of Pittsburgh ETD
    ETD Committee:
    ETD Committee TypeCommittee MemberEmailORCID
    Committee ChairTalbott, Evelyn Oeot1@pitt.edu
    Committee MemberSutton-Tyrrell, Kimtyrrell@edc.pitt.edu
    Committee MemberBrooks, Maria Moribrooks@edc.pitt.edu
    Committee MemberKorytkowski, Marymtk7@pitt.edu
    Title: Markers for Subclinical Atherosclerosis in Women with Polycystic Ovary Syndrome and Controls
    Status: Unpublished
    Abstract: Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder among women in the United States. Women with PCOS experience acne, excessive hair, weight gain and irregular periods. Unfortunately, these women also have cardiovascular disease (CVD) risk factors including obesity, inflammation and type 2 diabetes. It is challenging to determine when and if atherosclerosis is accelerated in women with PCOS compared to controls as many studies investigate subclinical atherosclerosis in young women and are limited by small sample sizes. The purpose of this dissertation is to investigate markers for subclinical atherosclerosis in women with PCOS and non-PCOS controls.The meta-analysis on carotid intima-media thickness (CIMT) showed that women with PCOS have greater CIMT compared to controls. The summary estimates of the difference are comparable to a seven year progression in CIMT. This analysis also revealed CIMT estimates were more constant across studies with higher quality assessments of CIMT. The investigation of serum complement protein C3 (C3) suggested C3 may be an inflammatory risk marker for CVD in women with PCOS and controls. C3 was associated with traditional CVD risk factors in women with PCOS and controls, and was associated with coronary artery calcium (CAC) after adjusting for case control status, age, and either insulin or BMI. In the fully adjusted model with African American race, C3 was significantly associated with the presence of CAC.The trajectory analysis of flow-mediated dilation in women with PCOS and controls identified three patterns of change in lumen diameter that were labeled as non-dilators, dilators and enhanced dilators. Baseline lumen diameter, insulin and HDLc were associated with group membership, and an interactive effect between PCOS status and total cholesterol on group membership was detected. The findings from this dissertation clarify the mechanisms of subclinical atherosclerosis in women with PCOS and controls. This is of public health importance because many women with PCOS may not realize they are at risk for CVD. It is critical to evaluate factors that put these women at an increased risk of CVD so researchers can monitor risk factors and develop interventions to prevent atherosclerosis in this high risk population.
    Date: 29 June 2011
    Date Type: Completion
    Defense Date: 11 April 2011
    Approval Date: 29 June 2011
    Submission Date: 01 April 2011
    Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
    Patent pending: No
    Institution: University of Pittsburgh
    Thesis Type: Doctoral Dissertation
    Refereed: Yes
    Degree: PhD - Doctor of Philosophy
    URN: etd-04012011-084022
    Uncontrolled Keywords: polycystic ovary syndrome; cardiovascular disease; PCOS; subclinical atherosclerosis
    Schools and Programs: Graduate School of Public Health > Epidemiology
    Date Deposited: 10 Nov 2011 14:33
    Last Modified: 06 Apr 2012 14:43
    Other ID: http://etd.library.pitt.edu/ETD/available/etd-04012011-084022/, etd-04012011-084022

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