Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2023; 11(6): 1318-1329
Published online Feb 26, 2023. doi: 10.12998/wjcc.v11.i6.1318
Metformin effect on internal carotid artery blood flow assessed by area under the curve of carotid artery Doppler in women with polycystic ovarian syndrome
Wisam Akram, Wassan Nori, Muna Abdul Ghani Zghair
Wisam Akram, Wassan Nori, Department of Obstetrics and Gynecology, Mustansiriyah, Al Saydihya 10052, Baghdad, Iraq
Muna Abdul Ghani Zghair, Department of Radiology, Mustansiriyah, Al Saydihya 10052, Baghdad, Iraq
Author contributions: Akram W and Nori W designed research and reviewed the data, wrote and revised the letter; Zghair MAG collected and analyzed the data; All authors have read and agreed on the final version of the manuscript.
Institutional review board statement: The ethical committee of Mustansiriyah University approved the study dated February/21/2019 (IRB No. 115).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no potential or real conflicts related to this paper.
Data sharing statement: All data are available on reasonable request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wassan Nori, PhD, Academic Editor, Academic Research, Senior Researcher, Department of Obstetrics and Gynecology, Mustansiriyah, No. 38, Al Amin Street, Al Saydihya 10052, Baghdad, Iraq. dr.wassan76@uomustansiriyah.edu.iq
Received: November 30, 2022
Peer-review started: November 30, 2022
First decision: January 19, 2023
Revised: January 19, 2023
Accepted: January 31, 2023
Article in press: January 31, 2023
Published online: February 26, 2023
Processing time: 85 Days and 12 Hours
Abstract
BACKGROUND

Insulin resistance (IR) was reported in most polycystic ovarian syndrome (PCOS) cases. Metformin, a biguanide drug, successfully reduced IR. Homeostatic Model Assessment for IR (HOMA-IR) and Doppler parameters assessed metformin's effectiveness.

AIM

To verify whether the area under the curve of the internal carotid artery (AUC-ICA) Doppler wave can be a useful marker for assessing IR among PCOS cases who presented with menstrual irregularity and were treated with metformin over 6 mo.

METHODS

An observational, cross-sectional study recruited 54 eligible PCOS women; the anthropometrics were as follows: age, body mass index (BMI), menstrual cycle days, biochemical serum cholesterol, low and high-density lipoprotein, sex hormone-binding globulin, fasting blood glucose, and HOMA-IR, hormonal testosterone, luteinizing hormone over follicle-stimulating hormone ratio, and ultrasonic pulsatility index (PI) and resistance index (RI), carotid artery intima-media thickness (CIMT) and (AUC-ICA) parameters were initially recorded and repeated 3 mo and 6 mo later with metformin tab 500 mg; three times/day for 6 mo. In addition, AUC-ICA was assessed by taking repeated systolic and diastolic wave height measurements.

RESULTS

Metformin caused a progressive reduction in BMI, menstrual cycle days, biochemical hormonal, and Doppler parameters (CIMT, PI, RI, and AUC-ICA). AUC-ICA correlated strongly to all PCOS parameters. AUC-ICA correlated inversely with treatment time (r = -0.98, P < 0.001) and positively with HOMA-IR (r = 0.98, P < 0.0001). Via the best subset regression model, the AUC-ICA had the highest predictive value for HOMA-IR.

CONCLUSION

AUC-ICA preceded PI, RI, and CIMT with a strong, meaningful correlation to all PCOS parameters, making it a reliable marker for the assessment of IR, especially during metformin therapy. Further studies are recommended to promote the application in practice.

Keywords: Carotid artery intima-media thickness; Insulin resistance; Internal carotid artery Doppler; Metformin; Polycystic ovarian syndrome

Core Tip: Women with polycystic ovarian syndrome (PCOS) suffer from insulin resistance and an atherogenic state evidenced by increased carotid artery intima-media thickness (CIMT). Fortunately, this increase in CIMT is reversible with metformin therapy, an insulin-sensitizing drug. Moreover, treated cases have restored ovulatory cycles and exhibited reduced androgen levels. First, we primarily aimed to examine whether the area under the curve of the internal carotid artery (AUC-ICA) Doppler is related to insulin resistance among PCOS women who presented with menstrual disturbances. Second, is to examine if AUC-ICA can be a useful marker in assessing changes in insulin resistance among treated cases with metformin for follow-up.