High sensitivity C - reactive protein (hs-CRP) and clinical characteristics, endocrine, metabolic profile in Indian women with PCOS: a correlation

Sunita Jaiprakash Ramanand, Jaiprakash B. Ramanand, Girish T. Raparti, Ravi R. Ghanghas, Nimish R. Halasawadekar, Praveenkumar T. Patil, Mayur P. P. Pawar, Mayur P. Shinde


Background: Role of hs-CRP was studied in PCOS women.

Methods: Correlation between serum hs-CRP and endocrine, metabolic profile was studied in 30 healthy women and 88 PCOS women. In PCOS women correlation between hs-CRP and clinical characteristics viz obesity, infertility, acne, hirsutism, acanthosis nigricans (AN) was also studied. Serum levels of hs-CRP, Luteinizing hormone (LH), Follicle stimulating hormone (FSH), LH:FSH ratio, Testosterone (Testo), fasting insulin, fasting blood glucose (FBG), total cholesterol (TC), triglyceride (Tg), low density lipoprotein (LDL), high density lipoprotein (HDL) and Homeostasis Model Assessment (HOMA) were estimated.

Results: Mean serum hs-CRP in PCOS women was higher than that in control women (6.9 ± SE 0.84 v/s 2.0 ± SE 0.19mg/L, P=0.005).  In PCOS group overweight/obese had higher hs-CRP as compared to normal weight women (P=0.0051). In control group hs-CRP was positively correlated with age (r=0.385 p=0.035) and LDL (r=0.38 P=0.036). PCOS women showed positive correlation between hs-CRP and cholesterol, LDL, fasting insulin, HOMA. PCOS women showed a significant negative correlation between hs-CRP and LH. AN positive PCOS women showed higher serum hs-CRP levels as compared to AN negative PCOS women (11 ± SE 0.7 v/s 5.5 ± SE 2.3, P=0.0439).

Conclusions: Serum hs-CRP is raised in Indian PCOS women reflecting association of low grade chronic inflammation. A positive correlation is present between hs-CRP and AN, insulin in PCOS women and obesity may aggravate this association. A positive correlation between hs-CRP and TC, LDL in the background of normal lipid profile is suggestive of precedence of chronic inflammation over dyslipidemia in PCOS.


PCOS, Obesity, Hirsutism, Acanthosis nigricans, hs-CRP

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Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;112:1805-12.

Ridker PM, Cook N. Clinical usefulness of very high and very low levels of C-reactive protein across the full range of Framingham Risk Scores. Circulation. 2004;109:1955-9.

Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW. C-reactive protein in healthy subjects: Associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol. 1999;19:972-8.

Festa A, D’Agostino R Jr, Howard G, Mykkanen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000;102:42-7.

Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989;38:1165-74.

Chris CJ Kelly, Helen Lyall, John R. Petrie, Gwyn W. Gould, John MC Connell, Naveed Sattar. Low Grade Chronic Inflammation in Women with Polycystic Ovarian Syndrome. J Clin Endocrinol Metab. 2001;86:2453-5.

Han TS, Sattar N, Williams K, Gonzalez-Villalpando C, Lean ME, Haffner SM. Prospective study of C-reactive protein in relation to the development of diabetes and metabolic syndrome in the Mexico City Diabetes Study. Diabetes Care. 2002;25:2016-21.

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19-25.

Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163-70.

Boulman N, Levy Y, Leiba R, Shachar S, Linn R, Zinder O, Blumenfeld Z. Increased C-reactive protein levels in the polycystic ovary syndrome: a marker of cardiovascular disease. J Clin Endocrinol Metab. 2004;89:2160-5.

Tosi F, Dorizzi R, Castello R, Maffeis C, Spiazzi G, Zoppini G, Muggeo M, Moghetti P. Body fat and insulin resistance independently predict increasedserum C-reactive protein in hyperandrogenic women with polycystic ovary syndrome. Eur J Endocrinol. 2009;161:737-45.

Escobar-Morreale HF, Luque-Ramirez, Gonzalez F. Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis. Fertil Steril. 2011;95:1048-58.

Hak AE, Stehouwer CD, Bots ML, Polderman KH, Schalkwijk CG, Westendorp IC et al. Associations of C-Reactive Protein With Measures of Obesity, Insulin Resistance, and Subclinical Atherosclerosis in Healthy, Middle-Aged Women. Arterioscler Thromb Vasc Biol. 1999;19:1986-91.

Ziccardi P, Nappo F, Giugliano G et al. Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation. 2002;105:804-9.

Kiddy DS, Hamilton-Fairley D, Bush A, Short F, Anyaoku V, Reed MJ et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992;36:105-11.

Pearson TA. Public policy approaches to the prevention of heart disease and stroke. Circulation. 2011;124:2560-71.

Robinson S, Pemberton P, Laing I, Nardo LG. Low grade inflammation, as evidenced by basal high sensitivity CRP, is not correlated to outcome measures in IVF. J Assist Reprod Genet 2008;25:383-8.

Oh JY, Lee JA, Lee H, Oh JY, Sung YA, Chung H. Serum C-reactive protein levels in normal-weight polycystic ovary syndrome. Korean J Intern Med. 2009;24:350-5.

Velija-Asimi Z. C-reactive protein in obese PCOS women and the effect of metformin therapy. Bosn J Basic Med Sci. 2007;7:90-3.

Ramanand SJ, Ghongane BB, Ramanand JB, Patwardhan MH, Patwardhan VM, Ghanghas RR et al. Hormonal Profile of Polycystic Ovary Syndrome (PCOS) In Indian Women. RJPBCS. 2012;3:1159-72.

Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999;22:141-6.

Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999;84:165-9.

Palmert MR, Gordon CM, Kartashov AI, Legro RS, Emans SJ, Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab. 2002;87:1017-23.

Norman RJ, Masters L, Milner CR, Wang JX, Davies MJ. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Human Reproduction. 2001;16:1995-8.

Morales AJ, Laughlin GA, Bützow T, Maheshwari H, Baumann G, Yen SS. Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syndrome: common and distinct features. J Clin Endocrinol Metab. 1996;81:2854-64.

McCartney RC, Prendergast KA, Chhabra S, Eagleson CA, Yoo R, Chang RJ et al. The Association of Obesity and Hyperandrogenemia during the Pubertal Transition in Girls: Obesity as a Potential Factor in the Genesis of Postpubertal Hyperandrogenism. The Journal of Clinical Endocrinology & Metabolism. 2006;91(5):1714-22.

Ajani UA, Ford ES, Mokdad AH. Prevalence of high C-reactive protein in persons with serum lipid concentrations within recommended values. Clin Chem. 2004;50:1618-22.

Ridker PM, Hennekens CH, Buring JE, Rifai N. C- reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836-43.