Racial and ethnic differences in the prevalence of metabolic syndrome and its components of metabolic syndrome in women with polycystic ovary syndrome: a regional cross-sectional study

• Published in: American journal of obstetrics and gynecology 2017-08, Vol.217 (2), p.189.e1-189.e8
• Main Authors: Chan, Jessica L., MD, Kar, Sujata, MD, Vanky, Eszter, MD, Morin-Papunen, Laure, MD, Piltonen, Terhi, MD, Puurunen, Johanna, MD, Tapaniennen, Juha S., MD, Rosa Maciel, Gustavo Arantes, MD, Hayashida, Sylvia Asaka Yamashita, MD, Saores, Jose Maria, MD, Baracat, Edmund Chada, MD, Mellembakkam, Jan Roar, MD, Dokras, Anuja, MD
• Format: Article
• Language: English
• Subjects: Adult; Brazil; Continental Population Groups; Cross-Sectional Studies; ethnicity; Female; Finland; Humans; India; metabolic syndrome; Metabolic Syndrome - epidemiology; Metabolic Syndrome - etiology; Norway; Obstetrics and Gynecology; polycystic ovary syndrome; Polycystic Ovary Syndrome - complications; Prevalence; race; United States; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2017.04.007

Background Polycystic ovary syndrome is a heterogeneous disorder and its presentation varies with race and ethnicity. Reproductive-age women with polycystic ovary syndrome are at increased risk of metabolic syndrome; however, it is not clear if prevalence of metabolic syndrome and clustering of its components differs based on race and ethnicity. Moreover, the majority of these women do not undergo routine screening for metabolic syndrome. Objective We sought to compare the prevalence of metabolic syndrome and clustering of its components in women with polycystic ovary syndrome in the United States with women in India, Brazil, Finland, and Norway. Study Design This is a cross-sectional study performed in 1089 women with polycystic ovary syndrome from 1999 through 2016 in 5 outpatient clinics in the United States, India, Brazil, Finland, and Norway. Polycystic ovary syndrome was defined by the Rotterdam criteria. Main outcome measures were: metabolic syndrome prevalence, blood pressure, body mass index, fasting high-density lipoprotein cholesterol, fasting triglycerides, and fasting glucose. Data from all sites were reevaluated for appropriate application of diagnostic criteria for polycystic ovary syndrome, identification of polycystic ovary syndrome phenotype, and complete metabolic workup. The US white women with polycystic ovary syndrome were used as the referent group. Logistic regression models were used to evaluate associations between race and metabolic syndrome prevalence and its components and to adjust for potential confounders, including age and body mass index. Results The median age of the entire cohort was 28 years. Women from India had the highest mean Ferriman-Gallwey score for clinical hyperandrogenism (15.6 ± 6.5, P < .001). The age-adjusted odds ratio for metabolic syndrome was highest in US black women at 4.52 (95% confidence interval, 2.46–8.35) compared with US white women. When adjusted for age and body mass index, the prevalence was similar in the 2 groups. Significantly more black women met body mass index and blood pressure criteria ( P < .001), and fewer met fasting triglycerides criteria ( P < .05). The age- and body mass index–adjusted prevalence of metabolic syndrome was highest in Indian women (odds ratio, 6.53; 95% confidence interval, 3.47–12.30) with abnormalities in glucose and fasting high-density lipoprotein cholesterol criterion and in Norwegian women (odds ratio, 2.16; 95% confidence interval, 1.17–3.98) with abnormali