Analysis of Factors Influencing Hyperlipidemia in Female Polycystic Ovary Syndrome Patients with Normal Body Mass Index

Abstract

Background In recent years, women with polycystic ovary syndrome (PCOS) have had a higher prevalence of lipid metabolism disorders, which are strongly associated with obesity and insulin resistance (IR) . Higher levels of lipid metabolism have been also found in PCOS women with normal body mass index (BMI) , but there are fewer studies on dyslipidemia in this population. Objective To investigate the factors influencing the development of hyperlipidemia in PCOS women with normal BMI. Methods Based on the data of the clinical trial Effect of Acupuncture and Clomiphene on Live Birth Rate in Women with Polycystic Ovary Syndrome (PCOSAct) , a total of 428 subjects with complete baseline data and meeting the study criteria were selected. The evaluation criteria for determining hyperlipidemia included total cholesterol (TC) 6.22 mmol/L and/or triglycerides (TG) 2.26 mmol/L and/or low-density lipoprotein (LDL) 4.14 mmol/L and/or high-density lipoprotein (HDL) <1.04 mmol/L, which was used to divide patients into the hyperlipidemia group (n=138 patients) and no hyperlipidemia group (n=290 patients) . The demographic characteristics, sex hormones, glucose and lipid metabolism, as well as cardiac enzymes and liver function were compared between patients with hyperlipidemia and those without hyperlipidemia, and multivariate logistic regression analysis was used to explore the factors influencing hyperlipidemia in PCOS women with normal BMI. Results The prevalence of combined hyperlipidemia in PCOS women with normal BMI was 32.24% (138/428) , and the most common type of dyslipidemia was reduced HDL levels with a high prevalence (21.73%, 93/428) of a single phenotype. There were 138 cases in the hyperlipidemia group and 290 cases in the no hyperlipidemia group. The hyperlipidemic group had higher age, proportion of family history of diabetes, body mass, waist circumference, BMI, WHR, longer duration of attempted pregnancy, higher levels of free androgen index, fasting insulin, insulin resistance index (HOMA-IR) , LDL, TC, TG, apolipoprotein B, alanine aminotransferase, aspartate aminotransferase, LDH than the no hyperlipidemia group, and higher levels of sex hormone binding globulin, anti-mullerian hormone, HDL, apolipoprotein A, total bilirubin, and direct bilirubin lower than the no hyperlipidemia group (P<0.05) . Multivariate logistic regression analysis revealed that age, BMI, HOMA-IR, and LDH were independent risk factors for the development of hyperlipidemia in PCOS patients with normal BMI (OR=1.170, 1.348, 1.172, 1.009) , and sex hormone binding globulin was independent protective factor (OR=0.979, P<0.05) . Conclusion The incidence of hyperlipidemia in PCOS women with normal BMI was 32.24%. Age, BMI, HOMA-IR, LDH, and SHBG are influencing factors of the development of hyperlipidemia in women with PCOS, and clinical measures should be taken to prevent or delay the occurrence and development of hyperlipidemia in women with PCOS according to the causative factors.

Keywords

• polycystic ovary syndrome|hyperlipemia|insulin resistance|body mass index|root cause analysis