The Plasma Homocysteine Concentrations and Relationship with Insulin Resistance in Young Women with Polycystic Ovary Syndrome

Women with polycystic ovary syndrome (PCOS) have several cardiovascular disease risk factors including hyperinsulinemia. Hyperhomocysteinemia is a recognized risk factor for atherosclerosis and has recently to be correlated positively with the hyperinsulinemia. We examined the relationship between plasma homocysteine levels and insulin resistance in patients with PCOS. Forty women with PCOS and 35 healthy subjects were studied. Hormonal assays, lipid pofile, homocysteine and fasting insulin levels, insulin resistance indices like HOMA and QUICKI determinations and ultrasound evaluation were performed in all subjects. The mean fasting insulin levels were significantly higher in women with PCOS than control women ( 12.02 ± 7.6 vs 6.08 ± 2.09 μU/ml) where as no difference in fasting glucose concentrations was observed between groups. Insulin resistance indices (HOMA and QUICKI) were significantly different between PCOS and control group (p<0.001). We found significantly higher mean plasma homocysteine concentrations in patients with PCOS as compared with controls ( 11.5 ± 2.71 vs 9.4 ± 1.8 μmol/L, p=0.002). When patients were stratified by body mass index (BMI), the homocysteine concentration were significantly higher in both obese and normal-weight women with PCOS than control women (11.65 ± 2.3, 11.15 ± 1.9, 9.4 ± 1.8 μmol/L, respectively). Fasting insulin concentrations and and insulin resistance indices were significantly different in obese PCOS patients as opposed to normal-weight women with PCOS although both obese and normal-weight PCOS patients were more insulin resistant than normal healthy volunteers. As a result, insulin resistance in women with PCOS is associated with elevated plasma homocysteine, regardless of body weight and together with other risk factors like dyslipidemia or hyperinsulinemia, elevated homocysteine levels may contribute to the risk of cardiovascular disease in women with PCOS.