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Polycystic Ovary Syndrome, Combined Oral Contraceptives, and the Risk of Dysglycemia: A Population-Based Cohort Study With a Nested Pharmacoepidemiological Case-Control Study
Diabetes Care ( IF 16.2 ) Pub Date : 2021-12-01 , DOI: 10.2337/dc21-0437
Balachandran Kumarendran 1, 2 , Michael W O'Reilly 3, 4 , Anuradhaa Subramanian 1 , Dana Šumilo 1 , Konstantinos Toulis 1 , Krishna M Gokhale 1 , Chandrika N Wijeratne 5 , Arri Coomarasamy 4 , Abd A Tahrani 4 , Laurent Azoulay 6 , Wiebke Arlt 4, 7 , Krishnarajah Nirantharakumar 1, 4
Affiliation  

OBJECTIVE

Irregular menstrual cycles are associated with increased cardiovascular mortality. Polycystic ovary syndrome (PCOS) is characterized by androgen excess and irregular menses; androgens are drivers of increased metabolic risk in women with PCOS. Combined oral contraceptive pills (COCPs) are used in PCOS both for cycle regulation and to reduce the biologically active androgen fraction. We examined COCP use and risk of dysglycemia (prediabetes and type 2 diabetes) in women with PCOS.

RESEARCH DESIGN AND METHODS

Using a large U.K. primary care database (The Health Improvement Network [THIN]; 3.7 million patients from 787 practices), we carried out a retrospective population-based cohort study to determine dysglycemia risk (64,051 women with PCOS and 123,545 matched control subjects), as well as a nested pharmacoepidemiological case-control study to investigate COCP use in relation to dysglycemia risk (2,407 women with PCOS with [case subjects] and without [control subjects] a diagnosis of dysglycemia during follow-up). Cox models were used to estimate the unadjusted and adjusted hazard ratio, and conditional logistic regression was used to obtain adjusted odds ratios (aORs).

RESULTS

The adjusted hazard ratio for dysglycemia in women with PCOS was 1.87 (95% CI 1.78–1.97, P < 0.001; adjustment for age, social deprivation, BMI, ethnicity, and smoking), with increased rates of dysglycemia in all BMI subgroups. Women with PCOS and COCP use had a reduced dysglycemia risk (aOR 0.72, 95% CI 0.59–0.87).

CONCLUSIONS

In this study, limited by its retrospective nature and the use of routinely collected electronic general practice record data, which does not allow for exclusion of the impact of prescription-by-indication bias, women with PCOS exposed to COCPs had a reduced risk of dysglycemia across all BMI subgroups. Future prospective studies should be considered for further understanding of these observations and potential causality.



中文翻译:

多囊卵巢综合征、复方口服避孕药和血糖异常风险:基于人群的队列研究和巢式药物流行病学病例对照研究

客观的

月经周期不规律与心血管死亡率增加有关。多囊卵巢综合症(PCOS)的特点是雄激素过多和月经不调;雄激素是多囊卵巢综合症女性代谢风险增加的驱动因素。复方口服避孕药(COCP)用于多囊卵巢综合征,既可以调节周期,也可以减少生物活性雄激素的含量。我们检查了 PCOS 女性的 COCP 使用情况和血糖异常(糖尿病前期和 2 型糖尿病)风险。

研究设计和方法

我们使用英国大型初级保健数据库(健康改善网络 [THIN];来自 787 个诊所的 370 万名患者)进行了一项回顾性人群队列研究,以确定血糖异常风险(64,051 名 PCOS 女性和 123,545 名匹配的对照受试者),以及一项巢式药物流行病学病例对照研究,旨在调查 COCP 使用与血糖异常风险的关系(2,407 名患有 PCOS 的女性,在随访期间有[病例受试者]和没有[对照受试者]诊断出血糖异常)。使用 Cox 模型来估计未调整和调整后的风险比,并使用条件逻辑回归来获得调整后的比值比 (aOR)。

结果

PCOS 女性血糖异常的调整后风险比为 1.87(95% CI 1.78-1.97,P < 0.001;根据年龄、社会剥夺、BMI、种族和吸烟进行调整),所有 BMI 亚组的血糖异常发生率均增加。患有 PCOS 并使用 COCP 的女性血糖异常风险降低(aOR 0.72,95% CI 0.59-0.87)。

结论

在这项研究中,由于其回顾性和使用常规收集的电子全科医疗记录数据(不允许排除处方偏倚的影响)的限制,暴露于 COCP 的 PCOS 女性发生血糖异常的风险降低涵盖所有 BMI 亚组。应考虑未来的前瞻性研究,以进一步了解这些观察结果和潜在的因果关系。

更新日期:2021-12-07
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