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Metformin administration improves endothelial function in women with polycystic ovary syndrome

Laiko Hospital, Medical School, University of Athens, Endocrine Section, First Department of Medicine, Athens, Greece, ¹ Alexandra University Hospital, Medical School, University of Athens, Vascular Laboratory, Department of Clinical Therapeutic, Athens, Greece and ² Laboratory of Biological Chemistry, University of Athens Medical School, Athens, Greece

(Correspondence should be addressed to E Diamanti-Kandarakis, Athens University School of Medicine, Laiko, General Hospital, 1A Zefyrou str, Athens 14578, Greece; Email: akandara{at}otenet.gr)

Objective: The aim of this study was to investigate the endothelial status in young women with polycystic ovary syndrome (PCOS), using a simple and easily reproducible hemodynamic method combined with a biological marker and to evaluate the effect of metformin treatment on these parameters.

Design: Descriptive clinical trial.

Methods: Forty young women, 20 with PCOS and 20 normal women of similar age and body mass index were studied. Metformin (1700 mg daily) was administered for 6 months to the PCOS group. The endothelium status and the metabolic and hormonal profile were studied in both groups, as well as after metformin, by flow-mediated dilatation (FMD) on the brachial artery and by measurements of plasma endothelin-1 (ET-1) levels.

Results: FMD was impaired in the PCOS group when compared with controls (3.24±0.71% vs 8.81±1.07% respectively, P < 0.0001), but this difference normalized after metformin treatment (PCOS_{post-metformin} vs controls: 8.17±1.26 vs 8.81±1.07%, P = 0.70) since the values significantly improved after metformin treatment (PCOS_{pre-metformin} vs PCOS_{post-metformin}: 3.24±0.71 vs 8.17±1.26%, P = 0.003). ET-1 levels were significantly higher in the PCOS women compared with the control group (7.23±0.50 vs 4.99±0.69 fmol/l, P = 0.01), they improved significantly after metformin treatment (PCOS_{pre-metformin} vs PCOS_{post-metformin}: 7.23±0.50 vs 3.57±0.60 fmol/l, P < 0.0001) and their difference compared with the control group was reversed (PCOS_{post-metformin} vs controls: 3.57±0.60 vs 4.99±0.69 fmol/l, P = 0.13). Metformin administration improved hyperandrogenemia. However, in this study, mathematical methods used to assess insulin resistance failed to show any detected alteration after treatment with metformin.

Conclusions: PCOS women were found to exhibit endothelial dysfunction compared with controls, which was reversed 6 months after metformin administration.

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