Endocrine Abstracts

Polycystic ovary syndrome (PCOS), which affects 7% of the female population, is associated with established cardiovascular risk factors including obesity, dyslipidaemia and insulin resistance. Thrombus formation represents the final step in the atherothrombotic process and clot structure has been shown to predict the predisposition to cardiovascular events. The aim of the present work was to assess the effects of commonly used therapeutic agents on clot structure and fibrinolysis in women with PCOS.

A total of 33 women with a mean age (CI) of 26.4 (23.5–29.3) were randomised to metformin 1.5 g/day (n=10), orlistat 360 mg/day (n=12) or pioglitazone 45 mg/day (n=11) in an open label parallel study. Blood samples were taken before and 19–20 weeks after treatment with these agents. Clot structure and fibrinolysis were subsequently assessed using a turbidimetric assay. The characteristics of blood clots formed ex vivo were studied using maximum absorbance, an indicator of clot density and time to 50% clot lysis. At baseline, a significant correlation was found between maximum absorbance and C-reactive protein (CRP) as well as body mass index (r=0.43, P=0.012; r=0.45, P=0.009 respectively), whereas a weak correlation was detected between lysis time and CRP (r=0.33, P=0.06).

There was no significant difference in clot maximum absorbance before and after treatment with metformin, orlistat or pioglitazone. However, these agents had an effect on lysis time (CI), which improved by 6% (2.3–11.6%; P=0.05), 10.5% (2.3–18.7%; P=0.03) and 18.7% (12.5–24.9%; P=0.002) after metformin, orlistat and pioglitazone treatment respectively.

This study shows that fibrinolysis can be modulated in patients with PCOS after treatment with metformin, orlistat or pioglitazone, an effect that is more pronounced with thiazolidinedione therapy. Furthermore, this work suggests that these agents, particularly pioglitazone, have cardiovascular protective properties in patients with PCOS.