Gregory S Pokrywka
Johns Hopkins University School of Medicine, USA
Title: Lipoprotein cardiovascular risk assessment and reduction in PCOS
Biography
Biography: Gregory S Pokrywka
Abstract
PCOS patients have increased cardiovascular risk according to a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. Women with PCOS with obesity, cigarette smoking, dyslipidemia, hypertension, impaired glucose tolerance and subclinical vascular disease are at risk. Those with metabolic syndrome and/or type 2 diabetes mellitus are at high risk for CVD. Lifestyle management is recommended for primary CVD prevention, targeting low-density and non-high-density lipoprotein cholesterol and adding insulin-sensitizing and other drugs if dyslipidemia or other risk factors persist. Lipid and lipoprotein abnormalities in PCOS consist of 1) High triglycerides and low HDL-C (ratio greater than 3:1 in insulin resistant states), 2) Small LDL particles are prevalent; LDL-C may be high, but is often (misleadingly) low or normal. 3) These numbers from the standard lipid panel represent serum concentrations of fats 4) Underlying these abnormalities lie the pathophysiology of this (and other) insulin resistant states: hyper-production of antherogenic beta lipoproteins from the liver (delayed clearance also plays a role) 5) HDL particles are often “dysfunctional” in IRS states like PCOS. HDL-C tells you nothing about HDL function! 6) Correction of this abnormal “lipoprotein trafficking” is the goal to reducing CVD risk in PCOS, not simply targeting the lipid abnormalities.