Possible beneficial effect of statin in women with poly cystic ovarian syndrome (PCOs)
Main Article Content
Keywords
Polycystic ovary syndrome, ovary polycystic disease, PCOS Statin, Atorvastatin, Simvastatin, Rosuvastatin, Lovastatin, Mevastatin, Pravastatin
Abstract
Statins, as lipid-lowering agents are likely not only to improve the dyslipidaemia associated with polycystic ovary syndrome but may also exert other beneficial metabolic and endocrine effects. Aim of the study: Reviewing, assessing the possible beneficial effect of statins therapy in women with poly cystic ovarian syndrome conceive. Search method: Electronic searching of databases including published Cochrane library, Menstrual Disorders and Subfertility Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) , MEDLINE ,EMBASE , PubMed in English language up to February 2016 using the following keywords: Polycystic ovary syndrome, ovary polycystic disease, PCOS Statin, Atorvastatin, Simvastatin, Rosuvastatin, Lovastatin, Mevastatin, Pravastatin. Inclusion Criteria: randomised studies in which any statin was compared with placebo or other agent(s), or any statin in combination with another drug was compared to another class of drug alone in women with PCOS are included , non randomized controlled trials were excluded . Data collection: selecting trials that have the inclusion criteria from the search results , printed and collecting data from each study for results presented using , excluded studies that did not meet the inclusion criteria Main results: Four trials fulfilled the criteria for inclusion. They comprised a total of 244 women with PCOS receiving 12 weeks or 6 weeks of treatment. Two trials (184 women randomised) studied the effects of simvastatin and two trials (60 women randomised) studied the effects of atorvastatin. There was no good evidence that statins improved menstrual regularity, spontaneous ovulation rate, hirsutism or acne, either alone or in combination with the combined oral contraceptive pill (OCP). Nor were there any significant effects on body mass index (BMI). Statins were effective in lowering testosterone levels (nmol/L) (mean difference (MD) -0.90, 95% CI -1.18 to -0.62, P < 0.00001, 3 RCTs, 105 women) when used alone or with the OCP. Statins also improved total cholesterol, low-density lipoprotein (LDL) and triglycerides but had no significant effect on high-density lipoprotein (HDL) levels, high sensitivity (HS) Creactive protein (HS-CRP), fasting insulin or homeostatic model assessment (HOMA) insulin resistance. No serious adverse events were reported in any of the included studies. Conclusions: Statins are effective in improving the lipid profile of women with PCOS, Statins, either alone or with the oral contraceptive pill (OCP), also improve the biochemical parameter of hyperandrogenaemia (reducing the level of total testosterone) but There is no good evidence that statins improve menstrual regularity, ovulation rate, hirsutism or acne in women with polycystic ovary syndrome (PCOS), and there are no data on the long term safety of statins in women with PCOS, no data are available about the long-term cardiovascular risk profile in women with PCOS
References
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3. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary
syndrome. Fertil Steril 2004;81:19–25.
4. Urbanek M. The genetics of the polycystic ovary syndrome. Nat Clin Pract Endocrinol Metab 2007;3:103–11. [PubMed: 17237837]
5. Lunde O, Magnus P, Sandvik L, Hoglo S. Familial clustering in polycystic ovarian syndrome. Gynecol Obstet Invest 1989;28:23–30. [PubMed: 2777131]
6. DeVane GW, Czekala NM, Judd HL, Yen SS. Circulating gonadotropins, estrogens, and androgens in polycystic ovarian disease. Am J Obstet Gynecol 1975;121:496. [PubMed: 125040]
7. Azziz R, Carmina E, Sawaya ME. Idiopathic hirsutism. Endo Rev 2000;21:347–62.
8. Choudhry R, Hodgins MB, Van der Kwast T, Brinkman AO, Boersma WJ. Localization of androgen receptors in human skin by immunohistochemistry: implications for the hormonal regulation of hair grown, sebacious glands, and sweat glands. J Endocrinol 1992;133:467–75. [PubMed: 1613448]
9. Baille A, Calman K, Milne J. Histochemical distribution of hydroxysteroid dehydrogenases in human skin. Br J Derm 1965;7:610–6.
10. Moghetti P, Toscano V. Treatment of hirsutism and acne in hyperandrogenism. Best Pract Res Clin Endocrinol Metab 2006;20(2):221–34. [PubMed: 16772153]
11. Amowitz LL, Sobel BE. Cardiovascular consequences of polycystic ovary syndrome. Endocrinol Metab Clin North Am 1999;28:439–58. [PubMed: 10352928]
12. Gambineri A, Pelusi C, Genghini S, et al. Effect of flutamide and metformin administered alone or in combination in dieting obese women with polycystic ovary syndrome. Clin Endocrinol 2004;60:241–9.
13. Diamanti-Kandarakis E, Mitrakou A, Raptis S, Tolis G, Duleba AJ. The effect of a pure anti-androgen
receptor blocker flutamide on the lipid profile in the polycystic ovary syndrome. J Clin Endocrinol Metab 1998;83:2699–705. [PubMed: 9709934]
14. Chen M-J, Yang W-S, Yang J-H, Chen C-L, Ho H-N, Yang Y-S. Relationship between androgen levels and blood pressure in young women with polycystic ovary syndrome. Hypertension 2007;49:1442–7. [PubMed: 17389259]
15. Speiser PW, Serrat J, New MI, Gertner JM. Insulin insensitivity in adrenal hyperplasia due to nonclassical steroid 21-hydroxylase deficiency. J Clin Endocrinol Metab 1992;75(6):1421–4. [PubMed: 1464643]
16. Diamond MP, Grainger D, Diamond MC, Sherwin RS, Defronzo RA. Effects of methyltestosterone on insulin secretion and sensitivity in women. J Clin Endocrinol Metab 1998;83(12):4420–5. [PubMed: 9851788]
17. Shaw LJ, Bairey Merz CN, Azziz R, et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health--National Heart, Lung, and Blood Institute sponsored Women’s Ischemia Syndrome Evaluation. J Clin Endocrinol Metab 2008;93(4):1276–84. [PubMed: 18182456]
18. Hull MG. Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies. Gynecol Endocrinol 1987;1:235–45. [PubMed: 3140583]
19. Wild S, Pierpoint T, Jacobs H, McKeigue P. Long-term consequences of polycystic ovary syndrome:results of a 31 year follow-up study. Hum Fert 2000;3(2):101–5.
20. Homburg R, Armar NA, Eshel A, Adams J, Jacobs HS. Influence of serum luteinising hormone concentrations on ovulation, conception and early pregnancy loss in polycystic ovary syndrome. Br Med J 1988;297:1024–6. [PubMed: 3142595]
21. Sagle M, Bishop K, Ridley N, et al. Recurrent early miscarriage and polycystic ovaries. Br Med J 1988;297:1027–8. [PubMed: 3142597]
22. Lunde O, Tanbo T. Polycystic ovary syndrome: A follow-up study on diabetes mellitus, cardiovascular disease, and malignancy 15-25 years after ovarian wedge resection. Gynecol Endocrinol 2007;23(12):704–9. [PubMed: 18075845]
23. Hardiman P, Pillay OC, Atiomo W. Polycystic ovary syndrome and endometrial carcinoma. Lancet 2003;361:1810–2. [PubMed: 12781553]
24. Pillay OC, Te Fong LF, Crow JC, et al. The association between polycystic ovaries and endometrial cancer. Hum Reprod 2006;21:924–9. [PubMed: 16361289]
25. Ratts VS, Pauls RN, Pinto AB, Kraja A, Williams DB, Odem RR. Risk of multiple gestation after ovulation induction in polycystic ovary syndrome. J Reprod Med 2007;52(10):896–900. [PubMed: 17977162]
26. Lin K, Coutifaris C. In vitro fertilization in the polycystic ovary syndrome patient: An update. Clin Obstet Gynecol 2007;50(1):268–76. [PubMed: 17304041]
27. Tummon I, Gavrilova-Jordan L, Allemand MC, Session D. Polycystic ovaries and ovarian hyperstimulation syndrome: a systematic review. Acta Obstet Gynecol Scand 2005;84:611–6. [PubMed: 15954867]
28. Dokras A. Cardiovascular disease risk factors in polycystic ovary syndrome. Semin Reprod Med 2008;26(1):39–44. [PubMed: 18181081]
29. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence and predictors of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999;22:141–6. [PubMed: 10333916]
30. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84:165–9. [PubMed: 9920077]
31. Ehrmann DA, Kasza K, Azziz R, Legro RS, Ghazzi MN. Effect of race and family history of type 2 diabetes on metabolic status of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:66–71. [PubMed: 15507516]
32. Palmert MR, Gordon CM, Kartashov AI, Legro RS, Emans SJ, Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab 2002;87:1017–23. [PubMed: 11889155]
33. Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health 2001;91(3):436–40. [PubMed: 11236410]
34. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004;103(2):219–24. [PubMed: 14754687]
35. Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol 2004;190(4):1091–7. [PubMed: 15118648]
36. Robinson HE, O’Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol 2005;106(6):1357–64. [PubMed: 16319263]
37. Myles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol 2002;100(5 Pt 1):959–64. [PubMed: 12423861]
38. D’Angelo R. Anesthesia-related maternal mortality: a pat on the back or a call to arms? Anesthesiology 2007;106(6):1082–4. [PubMed: 17525579]
39. Wali A, Suresh MS. Maternal morbidity, mortality, and risk assessment. Anesthesiol Clin 2008;26
(1):197–230. ix. [PubMed: 18319189]
40. Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol 2004;191(3):928–32. [PubMed: 15467566]
41. Mhyre JM, Riesner MN, Polley LS, Naughton NN. A series of anesthesia-related maternal deaths in Michigan, 1985-2003. Anesthesiology 2007;106(6):1096–104. [PubMed: 17525583]
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Jan 20, 2023
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Sarah Al Ramadhan. (2023). Possible beneficial effect of statin in women with poly cystic ovarian syndrome (PCOs). Journal of Population Therapeutics and Clinical Pharmacology, 30(1), 439–453. https://doi.org/10.53555/jptcp.v30i1.4725
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