MMP-9 belongs to the family of gelatinases that attack type IV collagen, laminin, and fibronectin.21 After these vascular proteins are attacked, it is believed that the coronary plaques make it clear are more vulnerable to rupture and thrombosis, which leads to acute vascular syndromes. Interestingly, MMP-9 is also expressed in the human ovary, and it is necessary for follicular rupture and oocyte release.22 These observations may be particularly relevant to PCOS patients. Abnormalities of coagulation that may contribute to an increase in atherosclerotic events have also been studied in the PCOS population. A recent report has shown that in PCOS patients without diabetes, global fibrinolytic activity was reduced compared with control subjects matched for age and body mass index (BMI).
23 Studies evaluating the levels of specific proteins have not consistently shown them to be abnormal in PCOS. The clustering of cardiac risk factors with PCOS, one of the most common reproductive abnormalities in young women, would seem to have public health implications if it were to be associated with an increased risk for the development of cardiovascular disease. Studies using noninvasive vascular assessment of atherosclerotic plaque, such as coronary calcium and carotid intimal medial thickness (cIMT) assessments, have confirmed a greater prevalence of disease in PCOS patients relative to the general population. In a recent evaluation of premenopausal women ages 30 to 45 years, the incidence of coronary calcium was significantly higher in women with PCOS, at 39%, compared with age- and weight-adjusted controls (21%) and community-dwelling women of similar age (only 9.
9%).24 Mean calcium scores were higher in the PCOS cohort compared with the age- and weight-adjusted controls. PCOS patients have also been found to have a higher prevalence of aortic calcification, another marker of atherosclerotic disease.25 Increases in cIMT thickness have been associated with an increase in cardiovascular events, in particular, stroke. Multiple investigators have found that patients with PCOS have a greater prevalence of abnormal cIMTs than the general population.26,27 In addition, Talbott and colleagues28 found a relationship between the degree of cIMT thickening in PCOS patients and levels of CRP.
In a cohort of women with a mean age of 33 years, although there were no differences in cIMT, earlier manifestations of vascular disease, including abnormalities in pulsewave velocity and brachial arterial flow-mediated vasodilation, were found.29 Evaluation Laboratory Studies It is essential when diagnosing PCOS to establish that the patient is euthyroid, has normal levels of prolactin and 17-hydroxyprogesterone, and has no manifestations of Cushing��s syndrome. Although PCOS patients present with irregular periods and hirsutism or alopecia, Anacetrapib laboratory studies are necessary to exclude other endocrinologic abnormalities or even life-threatening adrenal or ovarian tumors.