Cholesterol, Obesity, and Cardiac Risk in PCOS

Introduction:

• Polycystic ovary syndrome (PCOS), known earlier as a polycystic ovarian disease (PCOD) or Stein-Leventhal syndrome, is a common hormonal imbalance problem among women in their reproductive age.

• It is associated with the risk of diabetes, high blood pressure, cardiovascular diseases, and endometrial cancer.

• This condition makes it difficult for women to get pregnant.

• According to studies, about 10% to 15% of women face this problem during their reproductive life. In the United States, 6% to 12% of women are diagnosed with PCOS. This condition can continue after delivery also.

What Is Polycystic Ovary Syndrome?

• One of the common causes of female infertility is PCOS. An irregular menstrual cycle and infertility characterize the condition due to abnormal hormone levels. Sometimes affected women may not have periods, or they may not occur regularly. They encounter missed periods.

• The condition causes numerous small cysts in the ovaries that are formed along the outer edge of the ovary. Some may or may not have a cyst in their ovaries. The body has excess male hormones (androgens) and the eggs are not formed properly in the ovary and are not released during ovulation. The lack of ovulation causes the ovaries to start developing numerous small cysts.

• The progesterone hormone is also deficient in women since progesterone is needed to form eggs, and the ovaries fail to develop mature eggs. Instead, they develop small cysts in the ovaries, and such ovaries are called polycystic ovaries.

• Due to increased insulin levels, the ovaries release more androgens, suppressing the ovulation process. Women also develop insulin resistance that leads to excess glucose circulating in the blood. Elevated insulin level indicates insulin resistance that ultimately poses a risk for type 2 diabetes. Obesity and overweight are the contributing factors to insulin resistance.

Factors Contributing to PCOS Include:

• Genetic factor, X-linked autosomal dominant.

• Obesity.

• Family history of PCOS (mother, sister, or aunt with a previous history of PCOS).

• Diabetes.

• Chronic low-grade inflammation.

• Hyperinsulinemia (defect in insulin action or secretion).

What Are the Symptoms of Polycystic Ovary Syndrome?

• Irregular menstrual cycle with heavy bleeding during menstruation.

• Abnormal hair growth in the chest, abdomen, arms, and face.

• Acne on the back, face, and chest.

• Women with PCOS have obesity and trouble losing weight.

• Pockets of cysts lining the ovary.

• Hair thinning on the scalp (male pattern baldness).

• Inability to conceive because of lack of ovulation.

• Darkening of the skin (milky white patches) in the neck, armpit, and groin (between the legs).

• Androgen increases visceral fat in women.

• Pelvic pain.

• Hyperandrogenism.

• Difficulty getting pregnant.

• Increase in muscle mass due to androgen.

• Low back or lower abdominal pain during periods.

Women with PCOS are often insulin resistant. This condition is caused as their bodies can produce insulin but are not taken up by the tissues, which leads to excess insulin circulating in the blood.

How Does PCOS Impact Cardiac Health?

• Elevated cholesterol levels, high insulin, high blood pressure, and glucose tolerance are common in PCOS and contribute to developing cardiovascular diseases.

• Cholesterol is a fatty substance required to make vitamin D, hormones, and bile acids. The liver and intestine make up 80% of the cholesterol in the body. High cholesterol levels can bind with other substances in the blood, leading to plaque (fibrofatty tissue) that sticks to the artery walls. This fibrofatty plaque obstructs the blood flow, so the pressure is increased in circulation to push the blood through the blood vessels.

What Is the Link Between High Cholesterol Levels and Insulin Resistance in PCOS?

• Carbohydrates from the meal are broken down into glucose and absorbed through the intestinal wall. Then insulin, the primary regulator of carbohydrates, transports glucose to various parts of the cells. Insulin breaks the fat into fatty acids.

• During insulin resistance, the insulin receptors become unresponsive to insulin. It leads to elevated fat levels in the body. The LDL (low-density lipoprotein) and triglyceride result in fibrofatty deposits in the walls of the blood vessels. When cells no longer respond to insulin, there is an elevated blood glucose level.

• As a result of insulin resistance, patients may develop abnormal cholesterol profiles, an increase in low-density lipoprotein (LDL) or bad cholesterol, and a decrease in high-density lipoprotein (HDL) or good cholesterol and high levels of triglycerides.

• These cholesterol abnormalities increase the risk of heart diseases, like atherosclerosis (plaque formation in the artery) and stroke. Thus diabetes and cardiac diseases are interlinked in PCOS.

Lipid profile is highly influenced by PCOS that includes;

• Elevation in triglycerides (greater than or equal to 150 mg/dL).

• Decreased HDL cholesterol levels (less than 50 mg/dL).

• Increased LDL cholesterol levels.

• Increased VLDL cholesterol levels.

• Women suffering from PCOS have a greater risk of obesity and vice versa.

How Is Obesity Linked With Cardiovascular Disease?

• Insulin resistance is a contributing risk factor for obesity. Women with PCOS either have more insulin, or the insulin they produce does not work as it should. So the liver produces abnormal insulin levels to compensate for the high blood glucose level.

• The abnormal insulin levels in the body produce more male sex hormones and androgens. The androgens play a significant role in the increase of visceral fat. High visceral fats increase blood cholesterol levels, blood pressure, and the risk for type 2 diabetes. The women become vulnerable to the apple-shaped abdomen where the fat get deposited in the abdomen, which is highly risky for cardiovascular diseases.

• Obese patients have hypertension (high blood pressure), cholesterol abnormalities, and type 2 diabetes which are factors for heart diseases.

• Obesity can build up excess fat in the blood vessels. The high blood glucose and plaque build-up constantly insult the endothelium of the heart and cause vascular inflammation that results in coronary artery disease, heart attack, and stroke.

What Are the Diagnostic Tests for PCOS?

• Pelvic ultrasound.

• Laparoscopy.

• Specific blood test - Testosterone level test.

• Androgen level test.

• Follicle-stimulating hormone (FSH) test.

• Fasting cholesterol and triglyceride levels.

• Glucose tolerance test.

• Fasting blood glucose test.

• Blood pressure level check-up.

What Is the Treatment for PCOS?

Weight loss with a low-calorie or mediterranean diet prevents the risk of cardiovascular diseases. A mediterranean diet includes fruits, vegetables, whole grains, potatoes, beans, legumes, nuts, seeds, heart-healthy fats, spices, and extra virgin olive oil.

• This diet limits fried and processed food containing trans fats, which have no nutrition.

• The diet limits saturated fat and trans fat. Saturated fats can raise high LDL, which is responsible for plaque (fat and cholesterol build up in the blood vessels) formation (atherosclerosis) in the blood vessels. Trans fat has no nutrition. Both saturated and trans fats cause inflammation of blood vessels.

• The diet emphasizes healthy unsaturated fats, including omega-3 fatty acids. Healthy unsaturated fats fight high blood glucose levels, support brain health, and maintain cholesterol levels in the body.

• Women experience heavy bleeding during pregnancy which can cause anemia. They should consider taking iron-rich foods such as eggs, spinach, green leafy vegetables, and folic acid supplements.

• Hormonal birth control includes pills, shots, and an intrauterine device (IUD) that helps regulate the period cycle and treats acne and excess hair growth.

• Progestin therapy by taking progestin for 10 to 15 days for two months can regulate the menstrual cycle.

• Progestin helps with getting pregnant and inhibits androgen production.

• Exercise plays a vital role in weight management. An hour of exercise minimum for a day is compulsory.

• Gentle exercises, aerobic exercises, cycling, and swimming are recommended.

• Metformin is a drug used to treat diabetes as well as control insulin levels. These help with controlling the androgen level, and one can see improvements in their menstrual cycle.

• Avoiding smoking and alcohol.

• Essential oils from the plant have a variety of fragrances that help one feel good.

Conclusion:

PCOS can sometimes be difficult and frustrating for some women, but healthy food and lifestyle modifications can help cure this condition. There is no permanent cure for PCOS. But lifestyle changes, a good diet, and constant motivation can prevent all odds. Consulting a doctor and taking treatment is the best option. Under the expert guidance of the physician and by following a healthy lifestyle with required modifications, one can conceive naturally. A woman with PCOS can get pregnant despite this condition.