Effect of rosiglitazone on insulin resistance, C-reactive protein and endothelial function in non-obese young women with polycystic ovary symdrome

Objective: Women with polycystic ovary syndrome (PCOS) exhibit elevated levels of serum C-reactive protein (CRP) and impaired endothelium dysfunction which arc directly correlated with insulin resistance. Because rosiglitazone improves insulin sensitivity, we tested whether rosiglitazone treatment ameliorates high-sensitivity (hs)CRP levels and endothelial dysfunction in these patients. Design: Thirty-one women with PCOS were recruited (mean age, 24.7 +/- 3.9 (S.E.) years; mean body mass index (BMI), 25.6 +/- 3.2kg/m(2)). All women were treated with 4mg rosiglitazone daily for 12 months. Methods: Serum levels of testosterone, LH, FSH, sex hormone-binding globulin (SHBG), insulin and hsCRP were measured. The BMI, hirsutism scores and insulin sensitivity indices were calculated before and after treatment. Arterial endothelium and smooth muscle function was measured by examining brachial artery responses to endothelium-dependent and endothelium-independent stimuli before and after treatment. Results: After treatment with rosigitazone there were significant decreases in serum testosterone (91.2 +/- 37.5 vs 56.1 +/- 21.8 ng/dl; P < 0.01) and fasting insulin concentrations (12.5 +/- 7.6 vs 8.75 +/- 4.03 mu U/ml; P = 0.015). Insulin resistance indices were significantly improved after rosiglitazone treatment (P < 0.05). There were no significant changes in BMI, waist circumference, serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, FSH and LH levels. Hirsutism score was decreased significantly after treatment (10.8 +/- 1.8 vs 7.6 +/- 1.7; P < 0.05). Twenty-four of the women reverted to regular menstrual cycles. Levels of SHBG increased significantly after treatment (28.7 +/- 8.7 vs 48.4 +/- 11.2 nmol/l; P < 0.01). Serum hsCRP levels were decreased significantly after rosiglitazone treatment (0.25 +/- 0.1 vs 0.09 +/- 0.02mg/dl; P=0.006). There was also significant improvement in endothelium-dependent vascular responses after rosiglitazone treatment (9.9 +/- 3.9 vs 16.4 +/- 5.1%; P < 0.01). Conclusions: We conclude that rosiglitazone treatment improves insulin sensitivity in women with PCOS. It also decreases androgen production without significant weight gain. More importantly, it has beneficial effects on endothelial dysfunction and low-grade chronic inflammation in normal weight young women with PCOS.