By Louise Gagnon
TORONTO, CANADA -- June 7, 2007 -- Albuminuria may be considered a possible marker for cardiovascular disease in women with polycystic ovarian syndrome (PCOS), according to a study presented here at a poster session here at the 89th annual meeting of the Endocrine Society (ENDO).
The study retrospectively reviewed patient charts of 189 pre-menopausal women with PCOS who were defined as having the condition by National Institute of Health criteria and compared them to 81 control subjects from a single endocrinology practice.
"Studies show that when patients, even when they have no other disease states, are at high risk for cardiovascular disease when they have albuminuria," said Arti A. Patel, MD, the study's lead investigator and a fourth-year endocrinology fellow, Mount Sinai School of Medicine, New York, New York, United States.
A study published in Circulation in 2005 found that urinary albumin excretion in the upper normal range was a marker for adverse cardiovascular risk in normotensive, non-diabetic subjects. Since PCOS patients have increased presentation of the metabolic syndrome, researchers wanted to explore any link between the characteristics of the syndrome and urinary albumin excretion rates.
"Albuminuria has not been regarded as a feature of the metabolic syndrome," noted Dr. Patel. "Studies have not looked at any connection between PCOS and albuminuria."
Patients were excluded if they had diabetes, heart disease, kidney disease, lipid-lowering pharmacotherapies, and antihypertensive pharmacotherapies, with the exception of spironolactone. PCOS patients mean age was 28.8 and their mean body mass index was 29. Controls had a mean age of 37.5, and a mean BMI of 25.
Investigators defined low-grade albuminuria (LGA) as albumin-creatinine ratio (ACR) > 7 mg/g3. They defined metabolic syndrome according to Cholesterol Education Program guidelines.
Investigators took random single-voided urine samples to measure ACR. A total of 59 of the 189 PCOS subjects had LGA (31.2%). The rate was 35.8% in the control group. The metabolic syndrome was present in 16.8% (n=167) of women with PCOS and 2.9% (n=69) of control subjects. Dr. Patel noted that PCOS subjects and controls were not sufficiently matched for age or weight in the study, explaining why LGA rates were elevated in the control group.
Investigators found women with PCOS and LGA were more likely to have the metabolic syndrome, hypertension (blood pressure greater than or equal to 130/85 mmHg), and elevated alanine transaminase (ALT) measurements (ALT>40U/L) than women with PCOS whose ACR was less than or equal to 7 mg/g3: 30.9% vs. 9.8%, P =.001; 27.1% vs. 6.2%, P <.001; 10.2% vs. 1.5%, P =.006.
"We know PCOS patients are at risk for cardiovascular disease," said Dr. Patel. "We would like to stratify their risk for cardiovascular disease by checking for albuminuria, in particular if the ACR is greater than seven."
Future prospective research would determine if the presence of albuminuria could act as a marker for cardiovascular disease in women with PCOS, according to Dr. Patel.
The rates of usage of metformin and spironolactone were comparable amongst PCOS women with LGA and those with ACR less than or equal to 7 mg/g3.
The study was independently conducted.
Linda M. Charles contributed to this report.
[Presentation title: Low-Grade Albuminuria in Women with Polycystic Ovarian Syndrome. Abstract P4-196]
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