Racial and ethnic differences in the polycystic ovary syndrome metabolic phenotype

• Published in: American journal of obstetrics and gynecology Vol. 216; no. 5; pp. 493.e1 - 493.e13
• Main Authors: Engmann, Lawrence, MD, Jin, Susan, MPH, Sun, Fangbai, MPH, Legro, Richard S., MD, Polotsky, Alex J., MD, MSc, Hansen, Karl R., MD, PhD, Coutifaris, Christos, MD, PhD, Diamond, Michael P., MD, Eisenberg, Esther, MD, MPH, Zhang, Heping, PhD, Santoro, Nanette, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2017
• Subjects: Adolescent; Adult; Blood Glucose - analysis; Body Mass Index; ethnicity; Female; Hirsutism - ethnology; Humans; Hyperandrogenism - ethnology; Hypertriglyceridemia - ethnology; Insulin Resistance - ethnology; Metabolic Syndrome - ethnology; metabolism; Obstetrics and Gynecology; Phenotype; polycystic ovary syndrome; Polycystic Ovary Syndrome - ethnology; race; Racial Groups; Sex Hormone-Binding Globulin - analysis; sex steroids; Triglycerides - blood; Waist Circumference; Young Adult; phenotype; sex steroids; metabolism; ethnicity; race; polycystic ovary syndrome
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2017.01.003

Background Women with polycystic ovarian syndrome have a high prevalence of metabolic syndrome and type 2 diabetes mellitus. Blacks and Hispanics have a high morbidity and mortality due to cardiovascular disease and diabetes mellitus in the general population. Since metabolic syndrome is a risk factor for development of type 2 diabetes and cardiovascular disease, understanding any racial and ethnic differences in metabolic syndrome among women with polycystic ovarian syndrome is important for prevention strategies. However, data regarding racial/ethnic differences in metabolic phenotype among women with polycystic ovary syndrome are inconsistent. Objective We sought to determine if there are racial/ethnic differences in insulin resistance, metabolic syndrome, and hyperandrogenemia in women with polycystic ovarian syndrome. Study Design We conducted secondary data analysis of a prospective multicenter, double-blind controlled clinical trial, the Pregnancy in Polycystic Ovary Syndrome II study, conducted in 11 academic health centers. Data on 702 women with polycystic ovarian syndrome aged 18-40 years who met modified Rotterdam criteria for the syndrome and wished to conceive were included in the study. Women were grouped into racial/ethnic categories: non-Hispanic whites, non-Hispanic blacks, and Hispanic. The main outcomes were the prevalence of insulin resistance, metabolic syndrome, and hyperandrogenemia in the different racial/ethnic groups. Results Body mass index (35.1 ± 9.8 vs 35.7 ± 7.9 vs 36.4 ± 7.9 kg/m2 ) and waist circumference (106.5 ± 21.6 vs 104.9 ± 16.4 vs 108.7 ± 7.3 cm) did not differ significantly between non-Hispanic white, non-Hispanic black, and Hispanic women. Hispanic women with polycystic ovarian syndrome had a significantly higher prevalence of hirsutism (93.8% vs 86.8%), abnormal free androgen index (75.8% vs 56.5%), abnormal homeostasis model assessment (52.3% vs 38.4%), and hyperglycemia (14.8% vs 6.5%), as well as lower sex hormone binding globulin compared to non-Hispanic whites. Non-Hispanic black women had a significantly lower prevalence of metabolic syndrome (24.5% vs 42.2%) compared with Hispanic women, and lower serum triglyceride levels compared to both Hispanics and non-Hispanic whites (85.7 ± 37.3 vs 130.2 ± 57.0 vs 120.1 ± 60.5 mg/dL, P < .01), with a markedly lower prevalence of hypertriglyceridemia (5.1% vs 28.3% vs 30.5%, P  < .01) compared to the other 2 groups. Conclusion Hispanic women with polycystic ovarian syndrome have the most severe phenotype, both in terms of hyperandrogenism and metabolic criteria. Non-Hispanic black women have an overall milder polycystic ovarian syndrome phenotype than Hispanics and in some respects, than non-Hispanic white women.