Impact of mean arterial pressure on reproductive endocrine characteristics in infertile patients with polycystic ovary syndrome: a secondary analysis of a randomized clinical trial.

Objective: This study aims to evaluate the association between mean arterial pressure (MAP) and anthropometric, metabolic, and endocrine parameters in Chinese infertile women with polycystic ovary syndrome (PCOS).

Methods: A total of 1,000 PCOS subjects were enrolled in the clinical trial project of Acupuncture and Clomiphene in the treatment of PCOS infertility patients (PCOSAct). Of these, 998 patients were selected for this study. Linear trends and regression analyses were conducted to evaluate the association between MAP and anthropometric, metabolic, and endocrine parameters. Logistic regression was employed to estimate the association between MAP and risk of insulin resistance (IR), nonalcoholic fatty liver disease (NAFLD) and hyperlipidemia. The receiver operating characteristics (ROC) curve was used to determine the predictive value of the MAP for IR, NAFLD and hyperlipidemia.

Results: Linear trends revealed that the MAP was positively associated with age, height, body weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), hirsutism score, and acanthosis nigricans score, fasting blood glucose (FBG), fasting insulin (FINS), the homeostatic model assessment for insulin resistance (HOMA-IR), low-density lipoprotein (LDL), triglycerides (TG), total cholesterol (TC), apolipoprotein B (ApoB), ApoB/apolipoprotein A1 (ApoA1) ratio, total testosterone (TT), and free androgen index (FAI), as well as the prevalence of IR, metabolic syndrome (MetS), NAFLD, and hyperlipidemia. Conversely, MAP was negatively correlated with the quantitative insulin sensitivity check index (QUICKI), high-density lipoprotein (HDL), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), the LH/follicle stimulating hormone (FSH) ratio, and anti-Müllerian hormone (AMH). After adjusting for age and BMI, a significant linear relationship was observed between MAP and WC, WHR, hirsutism score, FBG, LDL, TG, TC, ApoB, and ApoB/ApoA1 ratio. Logistic regression analysis demonstrated that participants in the highest quartile (Q4) of MAP had no significantly higher odds ratios (OR) for IR, NAFLD and hyperlipidemia after adjusting for confounding factors. The ROC curve analysis indicated that the AUC_IR was 0.593 (95%CI: 0.557 ~ 0.629), with 85.9% sensitivity and 28.8% specificity at a cut-off value of 82.83, and the AUC_NAFLD was 0.621 (95%CI: 0.554 ~ 0.687), with 69.4% sensitivity and 53.5% specificity at a cut-off value of 87.17, and the AUC_{hyperlipidemia} was 0.555 (95% CI: 0.518 ~ 0.592), with 39.5% sensitivity and 70.00% specificity at a cut-off value of 90.83.

Conclusion: Elevated MAP is associated with dysregulation of glucose and lipid metabolism and alterations in endocrine hormone levels. It may thus serve as a promising screening approach for IR-related conditions in patients with PCOS.