Low sex hormone-binding globulin is associated with low high-density lipoprotein cholesterol and metabolic syndrome in women with PCOS

Background: Decreased high-density lipoprotein cholesterol (HDL-C) and sex hormone-binding globulin (SHBG) levels, and the metabolic syndrome, are all closely associated with a higher prevalence of atherosclerotic cardiovascular disease. We investigated the association between HDL-C, SHBG and the metabolic syndrome in women with polycystic ovary syndrome (PCOS). Methods and Results: Among 106 young Taiwanese women (mean age ± SD, 24.9 ± 4.8 years) with PCOS, 69 (65.1%) women had an HDL-C level <50 mg dl^-1. The level of HDL-C was highly correlated with that of serum SHBG (γ = 0.6034, P < 0.0001). The SHBG level was significantly lower in subjects with an HDL-C <50 mg dl^-1 than that in subjects with an HDL-C ≥50 mg dl^-1. Using multiple linear regression models with adjustment for age, BMI and other anthropometric, metabolic, liver function and hormonal variables, we showed serum SHBG to be independently correlated with HDL-C. Based on logistic regression analysis with adjustment for age, the SHBG level was significantly lower in women with PCOS with the metabolic syndrome (odds ratio = 0.92, P = 0.003). Conclusions: Low levels of SHBG in women with PCOS were associated with low levels of HDL-C, independent of insulin resistance and obesity. The SHBG level was inversely related to the occurrence of metabolic syndrome, further strengthening the potential link between SHBG levels and cardiovascular disease in women with PCOS.