Kumarendran, Balachandran 
ORCID: 0000-0001-7786-5932
(2024).
Metabolic health outcomes among women with polycystic ovary syndrome.
University of Birmingham.
Ph.D.
|
Kumarendran2024PhD.pdf
Text - Accepted Version Available under License All rights reserved. Download (4MB) | Preview |
Abstract
Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine condition among women. Previous studies hypothesised increased risk of NAFLD, OSA, and dysglycaemia among women with PCOS, but the role of BMI and serum androgens in this association was unclear.
Objective: We aimed, 1) To determine the risk of NAFLD, OSA and dysglycaemia among women with PCOS compared to women without PCOS. 2) To determine if risk of these outcomes is independent of BMI, 3) To determine the role of serum sex hormones (serum testosterone and serum Sex Hormone Binding Globulin -SHBG) on the risk of NAFLD and dysglycaemia, 4) To determine the risk factors (including clinical androgen excess features such as hirsutism) for these outcomes among the women with PCOS.
Methods: We used the DExtER app to extract three types of retrospective cohorts from a UK primary care database (THIN) for primary analysis and additional cohorts for sensitivity analysis. Women between the ages of 18 and 50 were eligible to be included in the study. The study period was 2000 to 2016. The primary cohorts included around 63,000 women with PCOS and around 120,000 women without PCOS who were matched for general practice, age (±1 year) and BMI (±2 kg/m2). We also developed additional independent cohorts of around 70,000 women with serum testosterone measurements, and around 40,000 women with serum SHBG measurements for NAFLD and dysglycaemia outcomes separately. We performed Cox regression with adjustment for important covariates and performed sensitivity analysis by restricting the analysis to incident exposures and PCOS only codes. We performed sub-group analysis and Cox regression to verify if the risk is independent of BMI. We used STATA software for the data analysis.
Results and conclusion: Compared to women without PCOS, women with PCOS had nearly twice the risk for NAFLD (adjusted HR = 2.23, 95% CI 1.86 ± 2.66, p < 0.001), OSA (adjusted HR = 2.26, 95% CI: 1.89–2.69, P < 0.001), and dysglycemia (adjusted HR = 1.87, 95% CI: 1.78–1.97, P < 0.001). This risk was similar in sensitivity analyses. The risk was independent of BMI for all three outcomes. We also observed the risk was higher with higher levels of serum testosterone and lower levels of serum SHBG for NAFLD and dysglycaemia. Clinical androgen excess features were risk factors for all three outcomes in women with PCOS. This study has limitations that are common to primary care database studies, such as its retrospective design, the lack of detailed information on the criteria used to diagnose PCOS and NAFLD, and OSA, and the lack of data on the laboratory assays used to measure serum androgens.
Conclusion: Compared to women without PCOS, women with PCOS have higher risk for NAFLD, OSA and dysglycaemia which is independent of BMI. We recommend a lower threshold for screening for NAFLD, OSA, and dysglycaemia among women with PCOS, and exploring the possibility of clinical trials to reduce this risk by managing androgen excess.
| Type of Work: | Thesis (Doctorates > Ph.D.) | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Award Type: | Doctorates > Ph.D. | ||||||||||||
| Supervisor(s): |
|
||||||||||||
| Licence: | All rights reserved | ||||||||||||
| College/Faculty: | Colleges (2008 onwards) > College of Medical & Dental Sciences | ||||||||||||
| School or Department: | Institute of Applied Health Research | ||||||||||||
| Funders: | None/not applicable | ||||||||||||
| Subjects: | R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine |
||||||||||||
| URI: | http://etheses.bham.ac.uk/id/eprint/14870 |
Actions
 |
Request a Correction |
 |
View Item |
Downloads
Downloads per month over past year