Download PDF
Exp Clin Endocrinol Diabetes 2014; 122(09): 553-557
DOI: 10.1055/s-0034-1377043
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Is Glycated Hemoglobin Related to other Dysmetabolic Variables Implicated in the Increase of Cardiovascular Risk in Polycystic Ovary Syndrome? A Comparative Study

S. F. de Medeiros
1   Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso – Cuiabá, MT, Brazil
2   Tropical Institute of Reproductive Medicine and Menopause – Cuiabá, MT, Brazil
,
J. S. Barbosa
2   Tropical Institute of Reproductive Medicine and Menopause – Cuiabá, MT, Brazil
,
M. A. S. de Medeiros
2   Tropical Institute of Reproductive Medicine and Menopause – Cuiabá, MT, Brazil
,
E. B. da Silva
2   Tropical Institute of Reproductive Medicine and Menopause – Cuiabá, MT, Brazil
,
A. C. M. C. de Souza
1   Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso – Cuiabá, MT, Brazil
,
M. M. W. Yamamoto
2   Tropical Institute of Reproductive Medicine and Menopause – Cuiabá, MT, Brazil
› Author Affiliations
Further Information

Publication History

received 31 January 2014
first decision 11 April 2014

accepted 21 May 2014

Publication Date:
11 June 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Background: In non-PCOS patients the concentration of glycated hemoglobin (HbA1C) has been employed to identify individuals at higher risk for impaired glucose tolerance (IGT) and diabetes mellitus. A few studies have examined the role of HbA1C in PCOS patients and current results are controversial.

Aim: To compare the strength of the association between glycated hemoglobin and other predictors of cardiovascular risk in polycystic ovary syndrome (PCOS).

Methods: This cross-sectional study enrolled 197 PCOS patients and 72 non-PCOS women. Transvaginal ultrasound, biochemical and hormone measurement were performed. Glycated hemoglobin (HbA1C) was correlated with other variables related to dysmetabolic/vascular diseases.

Results: The HbA1C levels were 6.0±1.4% and 4.9±0.4% in PCOS patients and non-PCOS controls, respectively (p<0.001). The HbA1C levels were≥5.7% in 46.4% of PCOS and in none of the control subjects (OR=90.8). HbA1C was well-correlated with several anthropometric, metabolic and endocrine parameters. Stepwise multiple regression including HbA1C and other known predictors of cardiovascular risk resulted in a significant model in which body mass index (BMI) and free testosterone exhibited the best correlation with HbA1C (adjusted R2=0.530; F=39.8; p<0.001).

Conclusion: HbA1C was elevated and correlated with anthropometric, biochemical and endocrine variables of metabolic/vascular disease risks in PCOS patients. Combined HbA1C, BMI and free testosterone levels provided a significant model with potential use to evaluate metabolic/vascular disease in PCOS patients.

Key words

glycated hemoglobin - polycystic ovary syndrome - glucose intolerance - dysmetabolic
 

  • References

  • 1 Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In Dunaif AGJ, Haseltine F. (eds.). Polycystic ovary syndrome. Blackwall Scientific. Boston: 1992: 377-384
    Google Scholar
  • 2 Goverde AJ, van Koert AJ, Eijkemans MJ et al. Indicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria. Hum Reprod 2009; 24: 710-717
    PubMedGoogle Scholar
  • 3 Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil Steril 2002; 77: 1095-1105
    CrossrefPubMedGoogle Scholar
  • 4 Wild RA, Carmina E, Diamanti-Kandarakis E et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 95: 2038-2049
    CrossrefPubMedGoogle Scholar
  • 5 American Diabetes Association. Standards of medical care in diabetes – 2013. Diabetes Care 2013; 36: S11-S66
    CrossrefPubMedGoogle Scholar
  • 6 Khaw KT, Warehan N, Bingham S et al. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 2004; 141: 413-420
    CrossrefPubMedGoogle Scholar
  • 7 Nathan DM, Turgeon H, Regan S. Relationship between glycated haemoglobin levels and mean glucose levels over time. Diabetologia 2007; 50: 2239-2244
    Google Scholar
  • 8 Lerchbaum E, Schewetz V, Giuliani A et al. Assessment of glucose metabolism in polycystic ovary syndrome: HbA1C or fasting glucose compared with the oral glucose tolerance test as a screening method. Hum Reprod 2013; 28: 2537-2544
    CrossrefPubMedGoogle Scholar
  • 9 Kim H, Bae S, Choe J. Impact of HbA1c Criterion on the detection of subjects with increased risk for diabetes among health check-up recipients in Korea. Diabetes Metab J 2012; 36: 151-156
    CrossrefPubMedGoogle Scholar
  • 10 Kim JJ, Choi YM, Cho YM et al. Prevalence of elevated glycated hemoglobin in women with polycystic ovary syndrome. Hum Reprod 2012; 27: 1439-1444
    CrossrefPubMedGoogle Scholar
  • 11 Salley KE, Wickham EP, Cheang KL et al. Position Statement: Glucose intolerance in polycystic ovary syndrome – A position statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007; 92: 4546-4556
    CrossrefPubMedGoogle Scholar
  • 12 Hurd WW, Abdel Rahman MY, Ismail SA et al. Comparison of diabetes mellitus and insulin resistance screening methods for women with polycystic ovary syndrome. Fertil Steril 2011; 96: 1043-1047
    CrossrefPubMedGoogle Scholar
  • 13 Celik C, Abali R, Bastu E et al. Assessment of impaired glucose tolerance with hemoglobin A1c and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study. Hum Reprod 2013; 28: 1062-1068
    CrossrefPubMedGoogle Scholar
  • 14 Azziz R, Carmina E, Dewailly D et al. Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006; 91: 4237-4245
    Google Scholar
  • 15 Gil-Junior AB, Rezende APR, Carmo AV et al. Adrenal androgen participation in the polycystic ovary syndrome. Rev Bras Gynecol Obstet 2010; 32: 541-548
    PubMedGoogle Scholar
  • 16 James WPT. Department of Health and Social Security and Medical Research Council Group. Research on obesity. A repot of the DHSS/MRC group. Her Majesty’s Stationary office; London: 1976
    Google Scholar
  • 17 Valdez R. A simple model-based index of abdominal adiposity. J Clin Epidemiol 1991; 44: 955-956
    CrossrefPubMedGoogle Scholar
  • 18 Wild RA, Vesely S, Beebe L et al. Ferriman Gallwey self-scoring I: performance assessment in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90: 4112-4114
    CrossrefPubMedGoogle Scholar
  • 19 Sowers SM, Derby C, Jannausch ML et al. Insulin resistance, hemostatic factors, and hormone interactions in pre- and perimenopausal women: SWAN. J Clin Endocrinol Metab 2003; 88: 4904-4910
    CrossrefPubMedGoogle Scholar
  • 20 Lujan ME, Jarrett BY, Brooks ED et al. Update ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod 2013; 28: 1361-1368
    CrossrefPubMedGoogle Scholar
  • 21 National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in adults (Adult treatment panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adults Treatment Panel III) final report. Circulation 2002; 106: 3143-3421
    PubMedGoogle Scholar
  • 22 Jellinger PS, Smith DA, Mehta AE et al. American Association of Clinical Endocrinologists' Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis: executive summary. Endocr Pract 2012; 18: 269-293
    CrossrefPubMedGoogle Scholar
  • 23 Matthews DR, Hosker JP, Rudenski AS et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419
    Google Scholar
  • 24 McAuley KA, Williams SM, Mann JI et al. Diagnosing insulin resistance in the general population. Diabetes Care 2001; 24: 460-464
    CrossrefPubMedGoogle Scholar
  • 25 Golland IM, Vaughan Williams CA, Shalet SM et al. Lack of predictive value of HbA1c for impaired glucose tolerance in polycystic ovary syndrome. Gynecol Endocrinol 1989; 3: 229-235
    CrossrefPubMedGoogle Scholar
  • 26 Mani H, Levy MJ, Davies JM et al. Diabetes and cardiovascular events in women with polycystic ovary syndrome: a 20-year retrospective cohort study. Lance 2013; 381: S70
    PubMedGoogle Scholar
  • 27 Orio Jr F, Palomba Spinelli L, Cascella T et al. The cardiovascular risk of young women with polycystic ovary syndrome: an observational, analytical, prospective case-control study. J Clin Endocrinol Metab 2004; 89: 3696-3701
    CrossrefPubMedGoogle Scholar
  • 28 Mannucci E, Ognibene A, Sposato I et al. Fasting plasma glucose and glycated haemoglobin in the screening of diabetes and impaired glucose tolerance. Acta Diabetol 2003; 40: 181-186
    CrossrefPubMedGoogle Scholar
  • 29 Syed IA, Khan WA. Glycated haemoglobin – a marker and predictor of cardiovascular disease. J Pak Med Assoc 2011; 61: 690-695
    PubMedGoogle Scholar