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Ovariancancer.
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Schildkrautetal.(1996)reporteda2.5fold(95%confidenceinterval(CI)=1.15.9)increasedriskofepithelialovariancanceramongwomenwithPCOSinapopulationbased,casecontrol
studyinvolving426cancercasesand4081controls.Theassociationwasfoundtobestrongeramongwomenwhoneverusedoralcontraceptives.Takentogether,thesedatasupportthe
s ocalledgonadotrophintheoryforthedevelopmentofovariancancer.AlthoughmorestudiesneedtobedonetoverifythefindingsofSchildkrautetal.(1996),therelativeprotection
affordedbyoralcontraceptivesagainstovariancancermustbetakenintoconsiderationwhenadvisingwomenwithPCOSwithnoimmediateinfertilityproblem.

Cardiovascularrisk

In1921,AchardandThiersdescribedthebeardeddiabetic,butitwasnotuntil1980thatmoresystematicresearchfocusedontherelationbetweenhyperandrogenismandhyperinsulinism
(Burghen,GivensandKitabchi,1980).WomenwithPCOSareclinicallycharacterizedbyobesity,hirsutism,oligomenorrhoeaandinfertility.Apartfromhormonalabberations,i.e.
hyperandrogenismandincreasedLH:FSHratio,increasedserumtriglyceridesanddecreasedhighdensitylipoprotein(HDL)cholesterollevelswerealsofound.Thesefindingsledtothe
proposalofpossiblecardiovascularrisk(Mattssonetal.,1984Wildetal.,1990).

ObesitywasthoughttobethecauseofhyperinsulinaemiainwomenwithPCOSuntilChangandcoworkers(1983)reportedthatwomenwithPCOSaremarkedlymoreinsulinresistantand
showenhancedinsulinsecretiononglucosestimulationcomparedtoweightmatchedcontrols.Sincethen,therehasaccumulatedanoverwhelmingamountofdocumentationonthe
correlationbetweenhyperandrogenismandhyperinsulinaemia,butthereisstillnoconsensusaboutwhetherhyperinsulinaemiaisthecauseortheresultofhyperandrogenism.Ontheother
hand,itisnowwellacceptedthathyperinsulinaemiaisinvolvedinthesocalledmetabolicsyndrome,characterizedbyobesity,inparticularcentralobesity,elevatedserumlevelsof
triglycerides,cholesterol,andinsulinresistanceinthetissues(Reaven,1988).Bothmenandwomenshowingfeaturesofthemetabolicsyndromehaveanincreasedriskofdeveloping
hypertensionanddiabetesmellitus.Indeed,anincreasedprevalenceofhypertension(see,forinstance,Dahlgrenetal.,1992bConwayetal.,1992)anddiabetesmellitus(Dunaifetal.,1987
Dahlgrenetal.,1992a)hasbeenfoundinwomenwithPCOS.Conwayetal.(1992),comparingleanandobesewomenwithPCOSwithrespecttothreecardiacriskfactorshyperinsulinaemia,
fastingserumlipidconcentrations,andraisedbloodpressurepresentedevidencethathyperinsulinaemicwomenwithPCOShaveanincreasedriskofdevelopingcardiovasculardisease.
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