Polikistik over sendromu olan hastalarda folik asitin kardiyovasküler risk parametrelerine etkisi

PURPOSE: This study has performed for patients with polycystic ovary syndrome (PCOS) especially with insulin resistance, because they compose the high risk patient group for developing cardiovascular disease over the long term. It is purposed to show positive effect of folic acid usage on clinic, hormonary, metabolic and cardiovascular risk parameters in these patients.METHOD: Seventy seven patients with PCOS diagnosis (according to Rotterdam criteria) and 40 healthy women for control group, who applied to Dokuz Eylul University Hospital Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Outpatient Clinic were included in this study. Patients with PCOS were divided into two groups according to usage of folic acid. Group 1 Forty four patients using 5 mg/day folic acid Group 2 Thirty three patients not using folic acid. Patients in both groups evaluated for antropometric and blood pressure measures and modified Ferriman Gallwey score. Fasting plasma glucose, fasting plasma insulin, C- reactive protein (CRP), folic acid, endothelin-1 (ET-1), ischemia modified albumin (IMA), apoprotein B (Apo B), apoprotein A1 (Apo A1), high density lipoprotein (HDL), low density lipoprotein (LDL), trigliserid, total cholesterol, homocysteine, follicule stimulating hormon (FSH), luteinizing hormon (LH), total testosteron, free testosteron, dehidroepiandrosteron sulfate (DHEAS) levels were measured. All patients? LH / FSH ratio and Apo B/A1 ratio, HOMA-IR (Homeostasis Model of Assessment - Insulin Resistance) index and free androgen index (SAI) were calculated. Both of ?20 µIU/mL fasting plasma insulin value + ?2.5 HOMA-IR and with the inclusion of HOMA-IR ?2.5, for both of two values patients divided into two groups as insülin rezistans positive and negative patients. All patients? carotis intima media thickness (CIMT), aorta diameter, arm and abdominale fat thickness were measured with ultrasonograpy by Dokuz Eylul University Hospital Radiology Department. All measurements were repeated after 3 months.RESULTS: Age and body mass index (BMI) values were not different in PCOS and control group, both groups consist of patients who were not obese. As compared to control group, istatistically significant differences between waist environment, waist-hip ratio and ultrasonographic waist fat thickness measurement, ovary volumes, LH/FSH ratios and HOMA-IR indexes, plasma insulin, trigliserid, total cholesterol, DHEA-S, homocysteine, ET-1 and IMA values, right-left CIMT and aorta diameter measurements in PCOS group. As we grouped PCOS patients, in group 1 with high folic acid levels, we found istatistically significant differences between beginning values of right and left CIMT measurements, plasma homosistein, folic acid and ET-1 levels as compared to other group. In all PCOS patients, significant positive corelations between homosistein and right-left CIMT measurements were found. In PCOS patients with positive insulin resistance, we confirmed strong, positive corelations between plasma homosistein levels and fasting plasma insulin and ET-1 values and HOMA-IR indexes. In PCOS patients with positive insulin resistance, significant decrease in homosistein levels have found by usage of folic acid. In the other hand, in patients with negative insulin resistance, it was found that there was no difference in plasma homosistein levels by the usage of folic acid. In group 1 patients with negative insulin resistance, ET-1 levels decreased significantly at the end of third month. In group 1 patients with positive insulin resistance, ET-1 levels were not effected by the usage of folic acid. In PCOS patients with positive insulin resistance; strong, positive, significant corelation was found between ET-1 and homosistein. In group 1, after the usage of folic acid for 3 months; we confirmed positive corelations between right-left CIMT and aorta measurements with the result of folic acid usage, negative corelation between plasma homosistein levels and plasma folic acid values, positive corelation with plasma glucose levels. In PCOS patient without insulin resistance, no correlation was found between homocysteine and all parameters are maintained.CONCLUSION: This study was featured that, in PCOS patients who were not obese, especially with positive insulin resistance; homosistein levels decreased by the increased level of folic acid. Homosistein was accused for the developing of cardiovascular diseases and vessel endothelin disfunction. Yet, it was featured that, CIMT decreased either, which was known as the noninvasive method of predicting cardiovascular disease.In PCOS, according to positive or negative insulin resistance, the effect of folic acid on ET-1 followed in detail and in PCOS patients with positive insulin resistance; strong, positive, significant corelation was found between ET-1 and homosistein. But, there was no decrease in insulin resistance by the usage of folic acid. The results found by this study were important because of predicting cardiovascular and metabolic diseases in early term of PCOS and necessity of needful cautions in early ages. It is yet early for thinking about the effect of folic acid usage for preventing the risk of cardiovascular disease for long term in patients with PCOS.