Jeanne V. Zborowski

Evidence for Association Between Polycystic Ovary Syndrome and Premature Carotid Atherosclerosis in Middle-Aged Women

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder characterized by obesity, hyperandrogenism, and insulin resistance. An adverse lipid profile has also been observed in PCOS-affected women, suggesting that these individuals may be at increased risk for coronary heart disease at a young age. The objective of the present study was to evaluate subclinical atherosclerosis among women with PCOS and age-matched control subjects. A total of 125 white PCOS cases and 142 controls, aged ≥30 years were recruited. Collection of baseline sociodemographic data, reproductive hormone levels, and cardiovascular risk factors was conducted from 1992 to 1994. During follow-up (1996 to 1999), these women underwent B-mode ultrasonography of the carotid arteries for the evaluation of carotid intima-media wall thickness (IMT) and the prevalence of plaque. A significant difference was observed in the distribution of carotid plaque among PCOS cases compared with controls: 7.2% (9 of 125) of PCOS cases had a plaque index of ≥3 compared with 0.7% (1 of 142) of similarly aged controls (P =0.05). Overall and in the group aged 30 to 44 years, no difference was noted in mean carotid IMT between PCOS cases and controls. Among women aged ≥45 years, PCOS cases had significantly greater mean IMT than did control women (0.78±0.03 versus 0.70±0.01 mm, P =0.005). This difference remained significant after adjustment for age and BMI (P <0.05). These results suggest that (1) lifelong exposure to an adverse cardiovascular risk profile in women with PCOS may lead to premature atherosclerosis, and (2) the PCOS-IMT association is explained in part by weight and fat distribution and associated risk factors. There may be an independent effect of PCOS unexplained by the above variables that is related to the hormonal dysregulation of this condition.

Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome

Abstract Objective: To determine whether testosterone levels change as women with the polycystic ovary syndrome (PCOS) grow older. Design: A follow-up cross-sectional study of a cohort of women with PCOS identified up to 20–25 years ago. Setting: Women with PCOS were recruited primarily from practice records between 1970 and 1990. Voter registration tapes and household directories were used to identify age-, race-, and neighborhood-matched controls. Participant(s): Eighty-four women with PCOS, 20–57 years of age, and 37 age-matched controls participating in a study of the risk for cardiovascular disease in women with PCOS. Intervention(s): Clinical data were collected by questionnaire and fasting blood samples were obtained randomly throughout the menstrual cycle. Main Outcome Measure(s): Total and non–SHBG-bound testosterone levels. Result(s): Total and non–SHBG-bound testosterone levels were similar in women with PCOS who were 20–42 years of age but were reduced by approximately 50% among women 42–47 years of age and remained stable in women older than 47 years of age. Testosterone levels were increased in younger and older women with PCOS compared with controls but were similar to controls in women 42–47 years of age. Conclusion(s): Hyperandrogenism partly resolves before menopause in women with PCOS. This change may explain the tendency of women with PCOS to cycle regularly as they grow older. Testosterone levels remain elevated in older women with PCOS, however, and may contribute to their increased risk for cardiovascular disease, endometrial cancer, and other diseases.

CARDIOVASCULAR RISK IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Compared with normal cycling women of similar age, women with polycystic ovary syndrome (PCOS) have an adverse lipid profile and an increased prevalence of Type II diabetes and hypertension. These woman also appear to have greater subclinical atherosclerotic disease, as demonstrated by greater carotid intimamedia wall thickness and higher levels of coronary calcification. Given the high prevalence of PCOS in the female population, this condition may potentially account for a significant proportion of the atherosclerotic heart disease observed in younger women. This article reviews the issues and uncertainties surrounding the PCOS-CHD association.

Evidence for competing effects of body mass, hyperinsulinemia, insulin resistance, and androgens on leptin levels among lean, overweight, and obese women with polycystic ovary syndrome ☆

OBJECTIVE To evaluate the relationships between leptin, body composition, insulin resistance, androgens, and reproductive indices among women with polycystic ovary syndrome (PCOS). DESIGN Matched case-control study. SETTING Academic reproductive endocrine practice; school of public health. PATIENT(S) Forty-six Caucasian women with PCOS and 46 population-based controls matched by age and body mass index (BMI). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Leptin, insulin, androgenic hormones, body composition parameters; reproductive parameters. RESULT(S) Overall, leptin levels among women with PCOS did not differ significantly from those of control women (20.4 +/- 14.9 vs. 21.9 +/- 14.3 ng/mL). However, within the lowest BMI tertile, women with PCOS had significantly lower leptin levels (9.6 vs. 18.3 ng/mL), comparable insulin, and higher testosterone concentrations than controls of similar body mass. Within the overweight and obese subgroups, both insulin and testosterone levels were increased among women with PCOS; leptin levels, although higher among obese cases, were not statistically different than those in controls. CONCLUSION(S) Below a certain BMI, hyperandrogenic women with PCOS have lower leptin levels than controls. Conversely, overweight and obese PCOS subjects appear to produce insufficient leptin for a given fat mass, relative to the degree of hyperinsulinemia, potentially because of the competing effects of adipocyte insulin resistance and androgens on leptin.

Is there an independent effect of polycystic ovary syndrome (PCOS) and menopause on the prevalence of subclinical atherosclerosis in middle aged women

Polycystic ovary syndrome (PCOS), a common reproductive endocrine condition manifests at puberty, and is characterized by hyperandrogenism, chronic anovulation, and obesity. PCOS cases exhibit an adverse coronary heart disease (CHD) profile at an early age, including insulin resistance, dyslipidemia and increased central adiposity. It can be hypothesized that the menopausal transition, whether natural or surgical, may provide an additional “insult”, resulting in greater cumulative risk to their vasculature. Coronary artery calcification (CAC), a measure of subclinical atherosclerosis (SCA), was measured by electron beam tomography in 149 PCOS cases and 166 controls (mean age 47.3 and 49.4 respectively). Cases had a higher prevalence of CAC (63.1%) compared to controls (41.0%), (p = 0.037) after adjustment for age and BMI. A total of 22 cases and 39 controls had undergone natural menopause, 12 cases and 26 controls underwent surgical menopause (with biochemical confirmation) and 115 cases and 101 controls reported being currently premenopausal. There was a significant difference in CAC values between cases and controls in all three-menopause categories including pre-menopausal, surgically induced and natural menopause (p < 0.001). Duration since menopause (years) and use of hormone replacement therapy were not different between cases and controls for the two menopause groups. Logistic regression was carried out with CAC ( ≤10 vs >10) as the dependent variable, and independent variables: PCOS status, current age, BMI, and menopausal status, (pre-menopause, surgical and natural menopause) and selected CHD risk factors. The data indicate that women with PCOS exhibit significantly increased CAC compared to controls after adjustment for age and BMI and menopausal status. PCOS status and fasting glucose were significant risk factors for CAC (p < 0.05). Both natural and surgical menopause were independent risk factors for CAC as well (p < 0.01). HDLT was of borderline significance, p < 0.10. Further follow-up of this cohort will be valuable in determining whether PCOS status continues to affect cardiovascular risk as they undergo the menopausal transition.

Risk of cancer as a result of community exposure to gasoline vapors.

Abstract The Tranguch Gasoline Spill leaked 50,000–900,000 gallons of gasoline from underground storage tanks, potentially exposing an area of Hazle Township and Hazleton, Pennsylvania, to chronic low levels of benzene since at least 1990. A retrospective cohort study of 663 individuals representing 275 households assessed whether affected residents were at increased risk for cancer from 1990–2000 compared with the Pennsylvania populace. Age-adjusted standard incidence ratios (SIRs) were calculated using Pennsylvania rates to determine expected numbers. The age-adjusted SIR for the gasoline-affected area was 4.40 (95% confidence interval: 1.09–10.24) for leukemia. These results suggest an association between living within the area affected by the Tranguch Gasoline Spill and increased risk for leukemia.

A retrospective investigation of PM10 in ambient air and cardiopulmonary hospital admissions in Allegheny County, Pennsylvania: 1995-2000.

Objective: Air quality in Allegheny County, Pennsylvania, has improved over the last decade, and we investigated whether the lower concentrations of fine particulate matter (PM10) are still associated with adverse health outcomes. Methods: Daily cardiopulmonary hospital admissions in elderly residents of Allegheny County and countywide average PM10 measures were available from 1995 through 2000. Using generalized additive models (GAM), a Poisson regression model was fit to the number of daily admissions using predictor variables: lags of PM10, daily temperature and humidity, day of the week, and time. Results: Our findings suggest that there is a positive association of PM10 with hospital admissions, and the effect is related to current-day PM10 levels. Conclusions: Even at the lower levels of ambient air pollution as measured by PM10, there is still a suggestion of an adverse health effect in the elderly.

Cigarette smoking and the risk of adult leukemia: results from the Three Mile Island cohort study.

Smoking is an unconfirmed risk factor for the development of leukemia. The authors examined the potential link using data from the Three Mile Island cohort for the period 1979-1995. Eligible for analysis were 24,539 individuals aged 14 years or older who were followed up over 16 years from the Three Mile Island cohort. The authors identified all incident leukemia cases through the Pennsylvania Department of Health Cancer Registry. They used the Cox proportional hazards model to evaluate the relationships and observed 42 incident leukemia cases, including 15 acute myeloid leukemia (AML) cases, in the cohort. After controlling for other confounding factors, the authors found current smoking to be associated with an increased risk of adult AML (relative risk = 3.47; 95% confidence interval = 1.002-11.99). The authors also observed a marginally significant linear trend of risk of AML associated with the number of years smoked (p = .06). The results from this study suggested that cigarette smoking was associated with an increased risk of adult AML. Further investigation is required to confirm these findings.

Connecting Environmental Health Data To People And Policy: Integrating Information And Mobilizing Communities For Environmental Public Health Tracking

Evaluation of available data is a critical preliminary step in the assessment of local environmental health. As part of a multi-organizational initiative to improve environmental health in the Pittsburgh, Pennsylvania region, the University of Pittsburgh Center for Healthy Environments and Communities (CHEC) interviewed 70 experts in the academic, government, non-profit, and private sectors and reviewed print and electronic resources to characterize environmental and public health data available in the region. The objectives of this undertaking were: to provide a conceptual framework for categorizing data locally on environmental hazards, exposures and health endpoints, to describe and evaluate the types of environmental public health data available nationally and locally, to identify existing endeavors to gather and categorize such data, and to present case studies on the real-life relevance of the availability or lack of availability of environmental health data. The purpose and relevance of this project, the evolution of the methodology, successes and challenges met, and anticipated next steps are presented. This process description and resulting comprehensive report is available to communities, at both the state and local health department level as well as lay community members, engaged in similar endeavors, to characterize their local and regional environmental health landscape. The framework outlined serves as background for a related statewide environmental health project sponsored by the Pennsylvania Department of Health through the Pennsylvania Consortium on Interdisciplinary Environmental Policy (PCIEP) and potentially as a foundation for community-based data evaluation for the National Environmental Public Health Tracking Program.

Case-crossover analysis of air pollution and cardiorespiratory hospitalizations: using routinely collected health and environmental data for tracking: science and data.

BACKGROUND From the early 1900s until its closure in February 1998, a Steel coke oven in Pittsburgh, Pennsylvania, was a key source of air pollution. A case-crossover study was performed to assess the associations between daily air pollution and cardiorespiratory (International Classification of Disease Ninth Revision [ICD-9]: 390-519) hospitalizations before and after plant closure and to evaluate how closure influenced these associations. METHODS Air pollution data, climatic data, and cardiorespiratory hospitalizations among residents ages 65 years and older were obtained for the period of 1996 through 2000 for the study area. Data were analyzed using a case-crossover design and conditional logistical regression. Two distinct referent-sampling approaches were compared. RESULTS Significant associations were observed between the fourth quartile in PM10 and cardiorespiratory hospitalizations (odds ratio [OR]: 1.12; 95% CI: 1.02-1.23) and cardiovascular hospitalizations only (ICD-9: 390-459) (OR: 1.13; 95% CI: 1.01-1.26) before the plant closure. After closure of the plant, PM10 was not significantly associated with cardiorespiratory or cardiovascular disease hospitalizations. Moreover, the referent sampling approaches did not greatly alter the estimations in the case-crossover analysis. CONCLUSIONS Existing secondary data are an economical source to assess the impact of point source pollution on the environmental landscape. The findings suggest that closure of the steel coke plant was associated with a reduction risk of the cardiovascular hospitalizations.