engleski

Polycystic ovary syndrome: a major unrecognized cardiovascular risc factor in women.

Prevalencija sindroma policističnih jajnika (SPJ) u žena reproduktivne dobi iznosi oko 10%, a uključuje amenoreju, hirzutizam, alopeciju, pretilost, uvećane policistične jajnike i hiperandrogenemiju. Proteklo je desetljeće proširilo značaj SPJ s područja reprodukcije i estetike na polje metaboličkih i kardiovaskularnih poremećaja. Naime, incidencija pretilosti, dijabetesa tip 2, hipertenzije i dislipidemije, te koronarne i vaskularne bolesti, veća je u žena žena reproduktivne dobi sa SPJ nego u onih s ”klasičnim” metaboličkim sindromom. Manifestna inzulinska rezistencija i hiperinzulinemija više su pravilo nego iznimka u ovih bolesnica, a iskazuju prevalenciju od 65 – 70 %. Istodobno, gotovo 70 % bolesnica sa SPJ ima abnormalan lipidni profil koji poput hiperlipidemije u dijabetičara uključuje značajno povećane vrijednosti ukupnog kolesterola, LDL-kolesterola i triglicerida, te snižene razine HDL-kolesterola. Mehanizam nastanka je jasan: hiperinzulinemija i hiperandrogenemija uzrokuju lipolizu, prateće povećanje slobodnih masnih kiselina u serumu i posljedičnu visoku hepatalnu sekreciju VLDL s izrazitom hipertrigliceridemijom. Opisan metabolički profil iskazuje veliki aterogeni potencijal. Iako često zanemarena, nužnost detaljne procjene kardiovaskularnog rizika i njegovog primjerenog liječenja u svake žene sa SPJ nije upitna, baš kao što nije upitna činjenica da je SPJ danas glavni zanemareni kardiovaskularni rizični čimbenik u žena. Istraživanja koja su u tijeku trebala bi donijeti odgovor na ključna otvorena pitanja: treba li postojanje SPJ u preventivnoj strategiji smatrati izrazito visokim pojedinačnim rizičnim čimbenikom poput preuranjene kardiovaskularne bolesti u obitelji, treba li SPJ možda izjednačiti s već razvijenom kardiovaskularnom bolešću poput dijabetesa, te treba li bolesnice sa SPJ tretirati po načelima i kriterijima sekundarne kardiovaskularne prevencije? Na sadašnjoj razini spoznaja, bez obzira kakvi budu odgovori na ova važna otvorena pitanja, već provedba sustavne brige o SPJ u rutinskom radu jamči značajan napredak u sadašnjoj kardiovaskularnoj prevenciji. The prevalence of polycystic ovary syndrome (PCOS) is estimated to be nearly 10% among reproductive-age women and includes amenorrhea, hirsutism, alopecia, obesity, enlarged polycystic ovaries and hyperandrogenemia. In the last decade, the importance of PCOS was expanded from the field of reproduction and aesthetics to the field of metabolic and cardiovascular disorders. Specifically, the incidence of obesity, type 2 diabetes, hypertension and dyslipidemia and coronary and vascular disease is higher in women of reproductive age women with PCOS than in those with "classic" metabolic syndrome. Manifest insulin resistance and hyperinsulinemia are more rule than the exception in these patients, and prevalence records 65-70%. Meanwhile, nearly 70% of patients with PCOS have abnormal lipid profile, such as hyperlipidemia in diabetes that involves significantly increased levels of total cholesterol, LDL-cholesterol and triglycerides and lower levels of HDL- cholesterol. The mechanism of creation is clear: hyperinsulinemia and hyperandrogenemia cause lipolysis, the accompanying increase in free fatty acids in the serum and the consequential high hepatal secretion of VLDL with extreme hypertriglyceridemia. Described metabolic profile shows a large atherogenic potential in numerous clinical trials with confirmed high prevalence of coronary, carotid and aortic atherosclerotic changes in patients with PCOS. Although often overlooked, the necessity of detailed assessment of cardiovascular risk and its appropriate treatment in every woman with PCOS is not questionable, just as the fact that PCOS is now a major neglected cardiovascular risk factor in women. The studies that are currently in progress should answer the key outstanding issues: whether the presence of PCOS in the preventive strategy needs to be considered as very high individual risk factor such as premature cardiovascular disease in the family, should PCOS be equated with already developed cardiovascular disease such as diabetes or whether patients with PCOS need to be treated according to the principles and criteria of secondary cardiovascular prevention? According to the current state of knowledge, no matter what are the answers to these important outstanding issues, implementation of systematic care for PCOS in routine work guarantees a significant improvement in current cardiovascular prevention.

cardiovascular risc factor ; polycyctic ovary syndrome

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