Women suffering form PCO(hyperinsulinaemia or hyperglycaemia) may die of heart attack or brain stroke at an early age than healthy women.

Endothelial dysfunction at an early age even at  teens age is not an uncommon assocation in PCO women , Who is responsible?

Why endothelial dysfunctions occur at an early age (teens) at an early age to some girls? Are there any warning symptoms which we Gynecologist ignore or parents overlook? Mechanisms involved is the  development of endothelial dysfunction at an early age even at  teens age, Who is responsible, It is Dr S K Pal-for not communicating the message that  “behind the cloud of secondary amenorrhea or even behind oligomenorrhea( there is thunder ( Cerebral stroke/Heart attach-thrombosis)-is there.

Let us  promise .: We should ,from today seriously treat the PCO with  oligomeno as nor all PCO have menstrual  abnormality neither all PCO are ovulatory, Nowadays, it is clear that PCOS is a pro-inflammatory state, and emerging data from West reaffirmed that  that chronic low-grade inflammation supports the development of meta­bolic aberration and ovarian dysfunction .What leads to damage to endothelium?? The scientists have suggested   the following:

·       Reduced synthesis and release of nitric oxide (NO).

·       Enhanced inactivation of NO after its release from endothelial cells.

·       Enhanced synthesis of vasoconstricting agents.

·       Insulin itself acts directly on the vascular endothelium and the smooth muscle cells by a hypertrophic effect.

Insulin stimulates both endothelin-1 and NO activity in the skeletal muscle cir­culation: an imbalance between the releases of these factors may be involved in the pathophysiology of endothelial dysfunction.

We the Gynecologist, if we take the charge of caring a teen of PCO must also know Nitric oxide signaling!!!! Who will teach us?? Metabolic physician?  They are too busy.  In normal women, aging per se is 'associated with progressive attenuation of nitric oxide signaling; in PCOS women, these changes are present in early adult life, predisposing polycystic ovarian syndrome patients to premature atherosclerosis; in fact, high levels of plasmU ADMA were found: endogenous NO synthase inhibitor NG-NG-dimethyl-L-arginine (ADMA) is a biochemical marker/mediator of endo­thelial dysfunction

Furthermore, the important role of obesity in the mechanism of endothelial dys­function in PCOS women was shown: in humans, adiponectin enhances endothelium-dependent and endothelium-independent vasodilatation, reduces levels of TNF-a, and diminishes its effects on endothelial cells , in turn, reduces neointimal thickening and proliferation of smooth muscle cells, inhibits endothelial cell proliferation and migration, inhibits endothelial effects of oxidized LDL, and

Attenuates growth factor effects on smooth muscle cells.

Surprise 7:_- CRP is the most reliable circulating marker of chronic low-grade inflamma­tion in PCOS, but unfortunately, how many of us estimate CRP in a case of anovulation or says oligomeno irrespective of BMI, abnormal behavior of growth factors. Is this test affordable for our population and if affordable is it treatable, CRP is the most reliable circulating marker of chronic low-grade inflamma­tion in PCOS. Recently, CRP was found to be a direct promoter of the atherosclerotic processes and endothelial cell inflammation leading to athero­thrombosis.

CRP has a direct role in the vascular inflammatory process stimulating the release of inflammatory cytokines and increasing endothelial expression of cellular adhe­sion molecules, which mediate leukocyte migration.

One recent study has suggested that increased cardiovascular risk may be seen in 83.3 % of the PCO women with CRP >2.42 mg/1...

CRP values <1 mg/1 are considered low risk, 1-3 mg/1 are considered intermedi­ate risk, and 3-10 mg/1 are considered high risk for cardiovascular disease .

Get acquanatied with has-CRP!!!  How relevant is estimation of has-CRP? IMT is an independent predictor of stroke and myocardial infarction Anatomic evidence of early coronary and other vascular diseases in PCOS women has been reported and increased and Metabolic physicians have time and again pointed out that, IMT has been linked to cardiovascular risk factors including dyslipi­demia and obesity, and it is considered an independent predictor of stroke and myocardial infarction.

The role of hs-CRP in predicting increased carotid intima-media thickness is not independent of BMI in PCOS

Relevance of Non pelvic USG in PCOS/ Obese women!!!The issue of Coronary artery calcification/ Vs Hepatic USG? To me it appears a late but good & reproducible another marker of atherosclerosis, is more com­mon in women with PCOS than in controls, even after adjustment for the effects of age and BMI

Statins reduce plasma triglycerides in a dose-dependent manner, and they also have a modest HDL-raising effect, which is not dose dependent.

Should we supplement lipid lowering agents and Vit D to all obese women? As dyslipidemia is a component of metabolic syndrome, atorvastatin and sim­vastatin have been used in PCOS women to investigate their effects on this common syndrome.

To date, there are limited data on the use of statins in PCOS, but short-term use of statins alone or in combination with metformin appears to improve lipid levels in PCOS. In a meta-analysis, statins were more effective than placebo in reducing total cholesterol, LDL, and triglycerides; lipid profile improvement occurred within the first 3 months of treatment, with no further significant change thereafter.

How many of us combine metformin with statins in PCOS women here dyslipidaema have been documented as well as HOMA-IR are positive? A combination of metformin with statins was more successful than metformin alone in lowering fasting glucose, fasting insulin, LDL cholesterol, and triglyce­rides.