Abstract
Introduction: Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk later in life. Insulin resistance, common in PCOS, heightens the risk of type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease. This study explored whether insulin sensitizers could modify traditional cardiovascular risk factors, through influence on insulin resistance.
Objectives: To evaluate the impact of Metformin and Myoinositol therapy on glycemic and lipid profiles in PCOS patients, based on body mass index (BMI).
Methods: A prospective, randomized clinical study was conducted at the UC for Endocrinology in Skopje (2022–2023). Women aged 18–40 with PCOS (Rotterdam 2003 criteria) were assigned to either Metformin (1500 mg XR) or Myoinositol (2 g + 200 mg folic acid TID) for 6 months. Parameters monitored included BMI, fasting plasma glucose (FPG), HOMA-IR, total cholesterol, LDL-C, HDL-C, triglycerides, lipid accumulation product (LAP), and TG/HDL ratio.
Results: Baseline BMI significantly influenced HDL, triglycerides, TG/HDL, and LAP. Myoinositol significantly improved cholesterol regardless of BMI. Among patients with BMI ≥25 kg/m², Metformin significantly reduced FPG (4.65 ± 0.5 vs 5.01 ± 0.3 mmol/L) and HOMA-IR (2.25 ± 0.6 vs 2.94 ± 1.1 mmol/L). HOMA-IR positively correlated with TG/HDL ratio (R=0.2086, p=0.016).
Conclusion: Myoinositol improved cholesterol in PCOS patients regardless of BMI. Metformin significantly affected glycemic control in overweight patients. The TG/HDL ratio may serve as a predictive marker for insulin resistance in PCOS.