Evaluation of the relationship between serum endocan and YKL-40 levels and cardiometabolic risk factors in patients with polycystic ovarian syndrome

Introduction: Polycystic ovary syndrome (PCOS) is thought to be one of the most common endocrinopathies in women, affecting 5-10% of women, depending on the population studied. The syndrome is clinically characterized by oligomenorrhea and hyperandrogenism, as well as frequent cardiovascular disease-related risk factors such as obesity, glucose intolerance, dyslipidemia, fatty liver, and obstructive sleep apnea. Endocan is a dermatan sulfate proteoglycan secreted by the vascular endothelium, reflecting endothelial activation. It has been suggested that endocan has an important role in the regulation of angiogenesis and the inflammatory process and can be used as a marker of vascular dysfunction and related cardiovascular risk. YKL-40 (Chitinase-3-like protein) is a glycoprotein secreted from macrophages and neutrophils in response to endothelial damage. Studies have found that increased levels of YKL-40 are associated with cardiovascular mortality in association with endothelial dysfunction. In this study, we aimed to determine whether endocan and YKL-40 levels in patients with PCOS can be used as a marker of increased cardiovascular risk in these patients. Materials and Methods: In our study, approximately 5 ml of venous blood was taken into biochemistry tubes for YKL-40 and endocan levels from 44 patients diagnosed with polycystic ovary syndrome in the Endocrinology outpatient clinic and 40 control groups (healthy volunteers), the sample was placed in flat plastic tubes with a protective inside and placed at 5°C. It was centrifuged at 4000 rpm for 5 min at C. The obtained samples were taken into Eppendorf tubes and stored at -80°C until the working day. Carotid intima media thickness (CIMT) was evaluated using ultrasonography in the endocrine outpatient clinic. In the diet outpatient clinic, the patient was measured with a TANITA measuring device to determine the body fat ratio. Height, weight and body mass index (BMI) were measured. Glucose, insulin, lipid parameters (LDL, HDL, triglyceride and total cholesterol), crp (c reactive protein), testosterone and dehydroepiandrosterone (DHEAS) levels of the patients and control group were taken from their files. Systolic and diastolic blood pressure measurements were made. HOMA-IR score was calculated according to glucose and insulin results. Serum endocan and YKL-40 levels were studied by ELISA method. Statistical calculations were made using the SPSS 22.0 (Statistical Package for Social Sciences) program. Continuous variables were given as mean ± standard deviation if the distribution was normal, and as the median (minimum-maximum) if the distribution was not normal. Significance test of the difference between two means in comparison of independent group differences when parametric test assumptions are met (Independent samples t test); When parametric test assumptions were not met, the Mann-Whitney U test was used to compare independent group differences. In addition, Pearson and Spearman correlation analyzes were used to examine the relationship between variables. For the differences, the p<0.05 level was considered statistically significant. Findings: Serum YKL-40 level was found to be higher in individuals with PCOS when compared to controls. However, this difference was not found to be statistically significant (p = 0.09). There was a statistically significant difference in serum endocan levels between the PCOS and control groups (p = 0.014). Serum endocan level was found to be high in the PCOS patient group. With serum endocan and YKL-40 levels; Correlation analyzes were used to determine whether there was a relationship between HOMA-IR score, BMI, insulin, crp, CIMT, total testosterone, DHEAS and lipid profile (triglyceride, HDL, LDL, cholesterol) measurements, which are important markers in cardiometabolic risk assessment. No correlation was found between Ykl-40 level and BMI, crp, CIMT, total testosterone, dheas and lipid profile (triglyceride, HDL, LDL, cholesterol) measurements. No correlation was found between endocan level and HOMA-IR score, BMI, insulin, crp, CIMT, total testosterone, DHEAS and lipid profile (triglyceride, HDL, LDL, cholesterol) measurements. In our study, a statistically significant correlation was found between YKL-40 and Endocan with r = .626 correlation value in both groups (p<0.05). Result: Polycystic ovary syndrome is associated with an increasing number of cardiovascular comorbidities. Although endocan was significantly increased in PCOS patients, a larger patient population and longer-term patient cohort are needed before its use as a CVD risk biomarker can be accepted. Likewise, although we found that YKL-40 was higher in patients with PCOS, we did not find a significant relationship with the control group, indicating that its use in determining CVD risk requires further research. Nevertheless, the significant correlation between endocan and YKL-40 indicates that these two parameters may be useful for predicting and monitoring cardiovascular disease risk.