Orlistat in Overweight and Obese Patients With PCOS
Orlistat in Overweight and Obese Patients With PCOS
Objective Obesity is frequently present in women with the polycystic ovary syndrome (PCOS) and aggravates insulin resistance (IR) and hyperandrogenemia. We aimed to assess the effects of orlistat combined with lifestyle changes in overweight and obese women with PCOS and body mass index (BMI)-matched controls.
Design Prospective study.
Patients We studied 101 women with PCOS (age 26·1 ± 6·4 years, BMI 34·5 ± 5·9 kg/m) and 29 BMI-matched women with normal ovulating cycles. All women were instructed to follow a low-calorie diet to exercise and were treated with orlistat 120 mg tid for 6 months.
Measurements Metabolic and endocrine characteristics of PCOS, blood pressure (BP) and lipid profile.
Results A significant and comparable reduction in BMI was observed in women with PCOS and controls. Systolic and diastolic BP decreased only in women with PCOS. Serum low-density lipoprotein cholesterol levels decreased in both women with PCOS and controls; however, this reduction was greater in controls. In contrast, serum high-density lipoprotein cholesterol levels did not change in women with PCOS and decreased in controls. Serum triglyceride levels decreased significantly and to a comparable degree in the two groups. Similarly, markers of IR improved significantly and to a comparable degree in women with PCOS and controls. Serum testosterone levels and the free androgen index decreased significantly in women with PCOS and did not change in controls.
Conclusions Orlistat combined with lifestyle changes induces substantial weight loss in women with PCOS, resulting in improvements in IR, hyperandrogenemia and cardiovascular risk factors.
Obesity is frequently present in women with polycystic ovary syndrome (PCOS) and appears to play an important role in the manifestations of this syndrome. Obesity contributes to the pathogenesis of the pivotal characteristics of PCOS, including infertility, hyperandrogenemia and insulin resistance (IR). In addition, weight loss has beneficial effects on the metabolic and endocrine abnormalities of PCOS.
In overweight and obese patients with PCOS, lifestyle changes represent first-line treatment. However, weight loss is frequently small with lifestyle changes alone and many women eventually regain weight. In these women, the combination of lifestyle changes with antiobesity agents might represent a useful option. The only currently available antiobesity agent in most countries is orlistat, which does not have systemic adverse effects and appears to exert beneficial effects not only on body weight but also on other cardiovascular risk factors, including type 2 diabetes mellitus (T2DM), hypertension and dyslipidemia. However, there are limited data on the effects of orlistat in women with PCOS, a population at increased risk of both T2DM and cardiovascular disease.
We previously reported our experience with orlistat in this population in smaller studies. The aim of the present larger report is to further evaluate the effects of orlistat combined with lifestyle changes on the metabolic and endocrine characteristics as well as on the cardiovascular risk profile of overweight and obese women with PCOS and body mass index (BMI)-matched women without PCOS.
Abstract and Introduction
Abstract
Objective Obesity is frequently present in women with the polycystic ovary syndrome (PCOS) and aggravates insulin resistance (IR) and hyperandrogenemia. We aimed to assess the effects of orlistat combined with lifestyle changes in overweight and obese women with PCOS and body mass index (BMI)-matched controls.
Design Prospective study.
Patients We studied 101 women with PCOS (age 26·1 ± 6·4 years, BMI 34·5 ± 5·9 kg/m) and 29 BMI-matched women with normal ovulating cycles. All women were instructed to follow a low-calorie diet to exercise and were treated with orlistat 120 mg tid for 6 months.
Measurements Metabolic and endocrine characteristics of PCOS, blood pressure (BP) and lipid profile.
Results A significant and comparable reduction in BMI was observed in women with PCOS and controls. Systolic and diastolic BP decreased only in women with PCOS. Serum low-density lipoprotein cholesterol levels decreased in both women with PCOS and controls; however, this reduction was greater in controls. In contrast, serum high-density lipoprotein cholesterol levels did not change in women with PCOS and decreased in controls. Serum triglyceride levels decreased significantly and to a comparable degree in the two groups. Similarly, markers of IR improved significantly and to a comparable degree in women with PCOS and controls. Serum testosterone levels and the free androgen index decreased significantly in women with PCOS and did not change in controls.
Conclusions Orlistat combined with lifestyle changes induces substantial weight loss in women with PCOS, resulting in improvements in IR, hyperandrogenemia and cardiovascular risk factors.
Introduction
Obesity is frequently present in women with polycystic ovary syndrome (PCOS) and appears to play an important role in the manifestations of this syndrome. Obesity contributes to the pathogenesis of the pivotal characteristics of PCOS, including infertility, hyperandrogenemia and insulin resistance (IR). In addition, weight loss has beneficial effects on the metabolic and endocrine abnormalities of PCOS.
In overweight and obese patients with PCOS, lifestyle changes represent first-line treatment. However, weight loss is frequently small with lifestyle changes alone and many women eventually regain weight. In these women, the combination of lifestyle changes with antiobesity agents might represent a useful option. The only currently available antiobesity agent in most countries is orlistat, which does not have systemic adverse effects and appears to exert beneficial effects not only on body weight but also on other cardiovascular risk factors, including type 2 diabetes mellitus (T2DM), hypertension and dyslipidemia. However, there are limited data on the effects of orlistat in women with PCOS, a population at increased risk of both T2DM and cardiovascular disease.
We previously reported our experience with orlistat in this population in smaller studies. The aim of the present larger report is to further evaluate the effects of orlistat combined with lifestyle changes on the metabolic and endocrine characteristics as well as on the cardiovascular risk profile of overweight and obese women with PCOS and body mass index (BMI)-matched women without PCOS.
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