Original ArticlePractice Patterns in Screening for Metabolic Disease in Women with PCOS of Diverse Race-Ethnic Backgrounds
Section snippets
INTRODUCTION
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women affecting an estimated 8 to 10% (1), with estimates as high as 18% in some populations (2). PCOS presents with a variety of phenotypes due to complex interactions between environmental and genetic influences. Furthermore, presentation may differ across the reproductive lifespan (3). As a result, the formal diagnosis has remained controversial, with 3 different proposed diagnostic criteria: the 1990
METHODS
This study protocol was approved by the BUMC Institutional Review Board. De-identified data for patients evaluated in this study were extracted from the BUMC clinical database, which is built from the electronic medical record (EMR). Cases of PCOS were identified by International Classification of Diseases, 9th revision (ICD9) code 256.4 on the problem list between January 1, 2006 and December 31, 2011. The presence of metabolic disease (obesity, MetS, T2D, hyperlipidemia [HL], NAFLD, and
RESULTS
From 2006 to 2011, the number of PCOS cases seen in BUMC ambulatory clinics doubled from 547 (Black: n = 194, Hispanic: n = 87, White: n = 156, Other: n = 110) to 1,159 (Black: n = 393, Hispanic: n = 184, White: n = 325, Other: n = 257); the overall number of women aged 18 to 50 seen in BUMC ambulatory clinics was 8,491 in 2006 and 23,811 in 2011. Women with PCOS in both 2006 and 2011 were generally young with high rates of obesity (Table 1). Racial-ethnic differences in characteristics were
DISCUSSION
Women with PCOS have an increased risk of metabolic disorders, particularly obesity, insulin resistance, and T2D, with onset at earlier ages than women without PCOS (3). As a result, women diagnosed with PCOS need comprehensive evaluation for metabolic disorders. To our knowledge, this is one of the first studies to assess if screening recommendations for metabolic disorders in women with PCOS are being followed. Approximately 75% of women did not receive the recommended laboratory metabolic
CONCLUSION
PCOS is the most common endocrine disorder in premenopausal women (8-10%) (1). Reducing rates of obesity, diabetes, and CVD in women with PCOS would help reduce the substantial chronic health burden these women face, as well as the associated financial cost to the healthcare system (37). To our knowledge, this is the first study to assess if screening recommendations for metabolic disorders in women with PCOS are being followed after the comprehensive position statement published by AACE in
DISCLOSURE
The authors have no multiplicity of interest to disclose.
ACKNOWLEDGMENTS
The authors wish to thank Linda Rosen, Director of the BUMC Clinical Database Warehouse, for extracting and collating the clinical data for this project and Nicole L. Glazer, PhD, for her assistance with data preparation. This project was supported in part by the following: Robert Dawson Evans Junior Faculty Merit Award (ADC), RO1-HL094755 (ADC), NIH-CTSI UL1RR25771 (ADC). A portion of the data presented in this manuscript was presented in abstract form at the 95th Annual Meeting of the
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Comprehensive evaluation of disparities in cardiometabolic and reproductive risk between Hispanic and White women with polycystic ovary syndrome in the United States: a systematic review and meta-analysis
2022, American Journal of Obstetrics and GynecologyCitation Excerpt :The degree to which cardiometabolic and reproductive aberrations may disproportionately impact diverse populations of women with polycystic ovary syndrome (PCOS) is poorly elucidated, although the theoretical risk is substantial and has biological plausibility.1 We and others have shown differences in cardiometabolic and reproductive risk profiles, metabolic syndrome (MetS) prevalence, prediabetes mellitus, and type 2 diabetes mellitus status across diverse cohorts with PCOS (Black, South Asian, Middle Eastern, and Indigenous vs White).1–22 However, our knowledge about the presence and magnitude of health disparities in Hispanic women with PCOS is limited.1,23
Disparities in cardio metabolic risk between Black and White women with polycystic ovary syndrome: a systematic review and meta-analysis
2021, American Journal of Obstetrics and GynecologyCitation Excerpt :The degree to which cardiometabolic aberrations may disproportionately impact diverse populations of women with PCOS is important yet understudied. We and others have shown differences in cardiovascular risk factors, metabolic syndrome (MetS) rate, prediabetes, and type 2 diabetes status across diverse populations of women with PCOS in the United States and worldwide, supporting the potential for cardiometabolic health disparities in Indigenous, South Asian, Middle Eastern, and Black women compared with White or Caucasian counterparts.7–25 The recent international evidence-based guideline for the assessment and management of PCOS emphasizes the need to further delineate these disparities to inform targeted diagnosis, monitoring, and management of high-risk clinical populations and subsequent adaptations of the guideline recommendations across geographic regions and clinical settings.26
Understanding the association of polycystic ovary syndrome and non-alcoholic fatty liver disease
2019, Journal of Steroid Biochemistry and Molecular BiologyCitation Excerpt :Such controversy may be due to the use of different diagnostic criteria and the variability in the manifestations of PCOS among different ethnic groups [73]. In general, ethnicity is a contributing factor to the presence of metabolic alterations in women who present PCOS [74], which could be related to the hirsutism that is present in approximately 65–75% of patients suffering from this syndrome with relevant differences according to ethnic origin and geographical location [71]. The health professional must take into account specific considerations in patients with PCOS manifestations since ethnic variability is a significant contributing factor to the metabolic presentation of PCOS.
A Review on Glycosylated Hemoglobin in Polycystic Ovary Syndrome
2016, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Recommended screening tests for metabolic syndrome in women with PCOS include HbA1c, lipid profile, and alanine aminotransferase/aspartate aminotransferase. Using HbA1c level has increased because of its moderate sensitivity and specificity compared with the OGTT for screening of metabolic disease in patients with PCOS.38,49 Anthropometric features such as weight and BMI in patients with PCOS have been studied in different investigations.18,56
Polycystic ovary syndrome with feasible equivalence to overweight as a risk factor for non-alcoholic fatty liver disease development and severity in Mexican population
2020, Annals of HepatologyCitation Excerpt :Such controversy might be due to the use of different diagnostic criteria and the variability in the manifestations of PCOS among different ethnic groups [21]. In general, ethnicity is a contributing factor to the presence of metabolic alterations in women who present PCOS [22], regardless, prevalence studies are lacking in Latin-American patients [9]. The objective of this study was to determine the frequency of NAFLD development and severity in Mexican patients with PCOS and matched-controls by age and body mass index (BMI).
Polycystic ovary syndrome: Approach to correction of metabolic disorders
2020, Reproductive Endocrinology
Published as a Rapid Electronic Article in Press at http://www.endocrinepractice.org on March 18, 2014. DOI:10.4158/EP13414.OR
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