The Prevalence of Polycystic Ovary Syndrome, Its Phenotypes and Cardio-Metabolic Features in a Community Sample of Iranian Population: Tehran Lipid and Glucose Study.
Level 4 - case-series / case-control
Cross-sectional population-based observational study
PubMed 35299965 · doi:10.3389/fendo.2022.825528
What was done
A cross-sectional population-based study evaluated 1,960 Iranian women aged 18–45 years from the Tehran Lipid and Glucose Study. Participants were categorized into: (1) PCOS by Rotterdam criteria (subdivided into phenotype A [hyperandrogenism + oligo-anovulation + polycystic ovarian morphology/PCOM], B [hyperandrogenism + oligo-anovulation], C [hyperandrogenism + PCOM], and D [oligo-anovulation + PCOM]); (2) non-PCOS women with one single criterion of PCOS; and (3) healthy eumenorrheic, non-hirsute women without PCOM (controls). Cardiometabolic profiles, lipid abnormalities, and metabolic syndrome (MetS) prevalence were compared using linear and median regression models adjusted for age and body mass index.
What was found
The prevalence of PCOS was 13.6% by NIH, 19.4% by Rotterdam, and 17.8% by AE-PCOS criteria. Among Rotterdam PCOS cases, phenotype distribution was 23.9% (A), 46.3% (B), 21.6% (C), and 8.2% (D). Among 1,580 non-PCOS women, 6.8% (n = 108) had isolated oligo/anovulation, 21% (n = 332) had isolated hyperandrogenism, 16.2% (n = 159) had isolated PCOM, and 62% (n = 981) were healthy controls. Hyperandrogenic phenotypes (A, B, C) showed worse adiposity indices and lipid abnormalities than controls, whereas phenotype D did not differ. MetS prevalence was significantly higher only in phenotype A compared to controls. Among single-criterion groups, isolated hyperandrogenism was associated with significantly higher waist-to-height ratio and hypertriglyceridemia, while other single-criterion groups did not differ from controls in cardiometabolic parameters.
Why it matters
Cardiometabolic risk in PCOS is largely concentrated in hyperandrogenic phenotypes—particularly the full-criteria phenotype A—indicating that routine metabolic risk screening is primarily indicated for patients with hyperandrogenic phenotypes rather than all PCOS presentations equally.
Limits
The cross-sectional design cannot establish causality or temporal progression. The cohort is restricted to an urban Iranian population, which may limit generalizability to other ethnicities. Numerical values for specific lipid levels, blood pressure, insulin resistance, or exact effect sizes were not reported in the abstract.