Endocrine Abstracts

Background: Polycystic ovary syndrome (PCOS) is common with a suggested prevalence of 6–7% in Caucasian women of reproductive age. The presence of cardiovascular risk factors of obesity, insulin resistance and dyslipidaemia may predispose women with PCOS to coronary heart disease, although this remains controversial. This study aimed to contrast and compare the changes in lipid profile and hs-CRP following treatment with metformin, orlistat and pioglitazone in women with PCOS.

Method: A randomised, open label, parallel study was undertaken comparing metformin (500 mg three times a day), orlistat (120 mg three times a day) and pioglitazone (45 mg once daily). Thirty Caucasian overweight women with PCOS fulfilling the Rotterdam criteria were recruited (mean age(±S.E.M.) 26.4(±1.5) years; body mass index 36.0(±1.2) kg/m²). Fasting blood was collected at 0800 h each day on 10 consecutive occasions at 4-day intervals, before and 12 weeks after treatment. No subject was diabetic or receiving other treatment. All subjects gave their informed written consent prior to entering the study that had been approved by the local research ethics committee.

Results: There was no difference in baseline age or BMI between groups. Hyperandrogenism and insulin resistance measured by HOMA-IR ((insulin×glucose)/22.5) reduced with all the three treatments. In the orlistat treated group, after 12 weeks there was a significant reduction in total cholesterol of 9.3±2.2% mainly through LDL cholesterol reduction (13.5±2.6%). HDL cholesterol increased significantly in the pioglitazone treated group (16.5±3.3%), but had no overall effect on total cholesterol. No change in the lipid parameters was seen with metformin. Pioglitazone treatment alone reduced hs-CRP significantly by 59.4±4.8%. BMI reduced significantly with metformin and orlistat, with a non-significant increase with pioglitazone.

Conclusion: Orlistat is more effective in improving the lipid profile while pioglitazone resulted in a more significant reduction in hs-CRP.