Original articleEffect of Metformin on Microvascular Endothelial Function in Polycystic Ovary Syndrome
Section snippets
Study Design and Treatment Allocation
We conducted an open-label study of women with PCOS randomized to metformin vs no treatment at Mayo Clinic in Rochester, Minnesota, from March 24, 2014, to November 18, 2016 (clinicaltrials.gov Identifier: NCT02086526). The study protocol was approved by the Institutional Review Board of Mayo Clinic. Written informed consent was obtained from each participant before study enrollment. Participants could not be taking any other medications for the treatment of PCOS for at least 3 months before
Results
In this study, 48 women with PCOS were randomly assigned to metformin (33 patients) or no treatment (15 patients). Four participants in the metformin treatment group (12.1%) and 2 participants in the no treatment group (13.3%) did not complete the trial (Figure 1A). Of the participants in the no treatment group who completed the trial, 13 continued the study to take metformin for 3 months (delayed start group). Among those, 12 participants completed therapy.
Table 1 shows the characteristics of
Discussion
The current study documents that treatment with metformin can improve peripheral endothelial function, but specifically in the subset of women with PCOS and endothelial dysfunction. This improvement in endothelial function was not mediated through changes in androgens, glucose metabolism, or insulin resistance. In addition, endothelial dysfunction was highly prevalent in our study population—15 of 42 women with PCOS (35.7%) had endothelial dysfunction (Table 2).
To our knowledge, only one
Conclusion
Metformin improves peripheral endothelial function in women with PCOS and endothelial dysfunction independent of changes in glucose metabolism, dyslipidemia, or presence of prediabetes. The study findings suggest that metformin has a direct effect on endothelial function in PCOS and that measurement of peripheral microvascular endothelial function can stratify and follow response to metformin treatment in PCOS.
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For Limelight, see page 2369
Grant Support: This study was supported in part by a St. Jude Medical Foundation Career Development Award in Cardiovascular Research, National Institutes of Health Building Interdisciplinary Careers in Women’s Health Award K12HD065987, and the National Center for Advancing Translational Sciences.
Potential Competing Interests: Dr Amir Lerman is a consultant for Itamar Medical Ltd, Shahal Medical Services Ltd, and Volcano Corporation/Philips Healthcare. Dr Lilach Lerman is a consultant for WeiJian Technology Co, Ltd.