Lifestyle interventions in women with polycystic ovary syndrome: A scoping systematic review of randomised evidence

Objective: Lifestyle interventions (LSI) are recommended as first-line treatment for polycystic ovary syndrome (PCOS), yet the strength of evidence underpinning LSIs effectiveness remains unclear. We systematically reviewed the literature on LSIs in PCOS, evaluated evidence quality and summarised recommendations for clinical practice. Material and methods: We searched MEDLINE, EMBASE and CENTRAL for all randomised trials evaluating any LSI in PCOS until April 2021. We extracted data on the LSIs’ characteristics, dietary composition, duration, implementation, compliance assessment, and reported outcomes. We evaluated the evidence gap using a network-map of evaluated interventions. Results: We screened 550 citations and included 79 trials (n=4659 women). Most trials were from high-income countries (57/79, 72%) over a decade ago (48/79, 61%) and enrolled obese/overweight women (57/77, 74%). BMI was the commonest reported outcome (58/79, 73%), followed by weight (49/79, 62%), and testosterone (45/79, 57%). More than half of the trials had high-risk of randomisation (51/79, 65%) and allocation bias (49/79, 62%). Only 27 were registered prospectively (27/79, 34%). Two-thirds evaluated a dietary intervention (70/79, 88%), most commonly a hypocaloric diet (32/70, 46%); nineteen evaluated a combined dietary with pharmacological intervention (19/79, 24%), six combined diet with physical or behavioural intervention (6/79, 8%), and only one trial included all four elements. Conclusions: Evidence on LSI in PCOS is of poor quality with high variations in trial design, comparisons, and outcome reporting. Hypocaloric diet is the most commonly recommended LSI intervention for primary care. Future trials are needed to evaluate pragmatic and simple LSIs in robust multicenter studies (AU)

Objetivo: Las intervenciones en el estilo de vida (LSI) se recomiendan como tratamiento de primera línea para el síndrome de ovario poliquístico (SOP), sin embargo, la solidez de la evidencia que respalda la efectividad de la LSI sigue sin estar clara. Revisamos sistemáticamente la literatura sobre la LSI en el SOP, evaluamos la calidad de la evidencia, y resumimos las recomendaciones para la práctica clínica. Material y métodos: Buscamos en MEDLINE, Embase y CENTRAL, todos los ensayos aleatorios que evaluaran cualquier LSI en el SOP hasta abril de 2021. Extrajimos datos sobre las características, la composición dietética, la duración, la implementación, la evaluación del cumplimiento y los resultados informados de los LSI. Evaluamos la brecha de evidencia utilizando un mapa de red de intervenciones evaluadas. Resultados: Examinamos 550 citas e incluimos 79 ensayos (n=4.659 mujeres). La mayoría de los ensayos se realizaron en países de ingresos altos (57/79, 72%), hace más de una década (48/79, 61%) e incluyeron mujeres obesas/con sobrepeso (57/77, 74%). El IMC fue el resultado informado con más frecuencia (58/79, 73%), seguido del peso (49/79, 62%) y la testosterona (45/79, 57%). Más de la mitad de los ensayos tuvieron alto riesgo de asignación al azar (51/79, 65%) y sesgo de asignación (49/79, 62%). Solo 27 se registraron de forma prospectiva (27/79, 34%). Dos tercios evaluaron una intervención dietética (70/79, 88%), más comúnmente una dieta hipocalórica (32/70, 46%); 19 evaluaron una dieta combinada con intervención farmacológica (19/79, 24%), 6 una dieta combinada con intervención física o conductual (6/79, 8%) y solo un ensayo incluyó los 4 elementos. Conclusiones: La evidencia sobre la LSI en el SOP es de mala calidad con grandes variaciones en el diseño de los ensayos, las comparaciones y los informes de resultados (AU)

Catecholamines in coronary sinus and peripheral plasma during pacing-induced angina in man.

We measured aortic and coronary sinus dopamine (DA), epinephrine (E), and norepinephrine (NE) in eight patients with cardiac ischemia (I) and eight control subjects (C). Samples were taken at rest (73 +/- 3 beats/min in C and 68 +/- 3 beats/min in I) and during coronary sinus pacing to peak rates (144 +/- 4 beats/min in C and 136 +/- 6 beats/min in I). Arterial NE was higher in the ischemic patients at rest (254 +/- 25 pg/ml in C and 324 +/- 21 in I; p less than 0.05). There were no differences in arterial E and DA. Neither pacing nor angina affected peripheral catecholamine concentrations. Resting myocardial NE flux was similar for both groups. With pacing, coronary sinus flow and net myocardial NE release increased significantly in both groups. The maximum relative increase in net myocardial NE release was less in the ischemic patients than in the controls (575 +/- 145% in C and 255 +/- 40% in I; p less than 0.05). Thus, angina induced by pacing does not augment peripheral sympathetic activity. Furthermore, pacing-induced angina appears to be associated with a decrease in cardiac sympathetic tone compared with that found in paced controls.