Response to Letter to the Editor From Jialal: "Higher Incidence of Metabolic Syndrome in Black Women With Polycystic Ovary Disease: A Longitudinal Study".

Dear Dr. Jialal,

Thank you for your letter and for applauding our study describing racial disparities in incidence of metabolic syndrome (MetS) among women with PCOS.

In our study, we observed differences in the prevalence of the low high-density lipoprotein cholesterol (HDL-C) criterion for MetS among Black women compared to White women with polycystic ovary syndrome (PCOS). This observation is consistent with our prior findings in a retrospective cross-sectional cohort study including 519 PCOS subjects and 1261 age- and race-matched controls from the National Health and Nutrition Examination Survey data set (1). In this PCOS cohort, mean serum HDL-C levels were significantly lower in Black women compared to White women (49.24 vs 55.05 mg/dL, P < 0.01). Further, there was a significant difference in the prevalence of low HDL-C criterion (<50 mg/dL) in adult Black women with PCOS (76.6%) compared to White women with PCOS (35.6%, P < 0.01 after controlling for age and body mass index). In contrast, we noted no difference in the prevalence of low HDL-C levels between Black and White women from the National Health and Nutrition Examination Survey population. Some studies have reported lower serum HDL-C levels in hyperandrogenic PCOS phenotypes compared to non-hyperandrogenic PCOS phenotypes, suggesting a link between androgens and HDL-C levels (2). Of note, in our study, only women with the hyperandrogenic PCOS phenotype were included.

There is growing evidence to suggest that PCOS may be a state of low-grade chronic inflammation, and serum high-sensitivity C-reactive protein levels are elevated independent of obesity (3). We were unable to assess differences in inflammation in our retrospective study design, as biomarkers such as high-sensitivity C-reactive protein are not routinely evaluated during the diagnosis and management of PCOS. Future studies designed to investigate our observations of higher prevalence of MetS in Black women with PCOS should be targeted at both understanding the underlying pathophysiology and the impact of socioeconomic determinants of health.