Introduction
Recently, we read a systematic review and meta-analysis written by Zhuang et al. (1), which is of great clinical significance and value. It was found that high-baseline blood pressure and dyslipidemia were common in women of reproductive age with PCOS: mainly, the increase of SBP and DBP, TG, nonHDL-C, and LDL-C and the decrease of HDL-C. However, these changes seem to have nothing to do with BMI.
Discussion
There were four retrieved databases mentioned in the abstract (the Cochrane Library, EMBASE, MEDLINE, and PubMed), but only three (the Cochrane Library, EMBASE, and MEDLINE) were demonstrated in the Search Strategy. The search strategy formats of PubMed and MEDLINE are different, but they are the same in this review, so the authors should clarify which one this strategy refers to. Meanwhile, the expression of medical subject headings in Pubmed-Medline (Table 1) sometimes used “mh” and sometimes used “Mesh.” It is recommended to use the same expression in one database. In addition, the search terms for different databases in the Study Design were not consistent. Adopting a proven and reliable search strategy is very necessary to obtain all the relative studies.
Table 1
| No | Author | Indicator | In original review | In included article |
|---|---|---|---|---|
| 1 | Adali et al. (2) Erdogan et al. (3) Ketel et al. (4) Long et al. (5) Luque-Ramirez et al. (6) Shroff et al. (7) |
BMI | The BMI of PCOS group and control group should be matched. | No mention matching |
| 2 | Akram et al. (8) | Number of control group | 50 | 30 |
| BMI | PCOS 23.3 ± 0.67 Control 21.8 ± 1.02 | PCOS 23.6 ± 0.50 Control 23.5 ± 0.71 |
||
| 3 | Adali et al. (2) | BMI | / | PCOS 24.40 ± 4.23 Control 23.90 ± 3.95 |
| 4 | Alexandraki et al. (9) | BMI | PCOS 25.41 ± 0.80 Control 25.05 ± 1.19 | PCOS 27.42 ± 1.12 Control 25.0 ± 1.19 |
| SBP | / | PCOS 114.81 ± 2.85 Control 111.6 ± 2.32 |
||
| DBP | / | PCOS 73.89 ± 2.25 Control 71.30 ± 1.70 |
||
| 5 | Berneis et al. (10) | Number of two groups | PCOS 30 Control 24 |
PCOS 42 Control 37 |
| BMI | PCOS 28.4 ± 5.8 Control 28 ± 4.4 |
PCOS 27 ± 5 Control 26 ± 4 |
||
| Age | PCOS 25.1 ± 4.2 Control 25.5 ± 3 |
PCOS 28 ± 7 Control 31 ± 2 |
||
| 6 | Kargili et al. (11) | TG | / | PCOS 90.9 ± 28.2 Control 89.0 ± 22.5 |
| 7 | Ni et al. (12) | HDL | Outcomes include HDL-C | Not found |
| 8 | Shroff et al. (7) | NonHDL | Outcomes include nonHDL-C | Not obtained, no TC |
| 9 | Yildiz et al. (13) | Number of PCOS group | 595 | 59 |
Extracted information do not match in original review and in included article.
For the Study Selection and Criteria section, the inclusion and exclusion criteria were relatively clear. As mentioned in this article, the BMI of the PCOS group and control group should be matched, and their age should be roughly in one range. However, only parts of the included articles were explicitly BMI-matched; more details are shown in Table 1. Additionally, it is better to clarify the exact meaning of “roughly in one range.” Finally, there was a contradictive expression about language. The exclusion criteria mentioned articles published in languages other than English, but the authors declared they operated “without any language restriction” during retrieval in the Search Strategy section.
For the Data Extraction section, since nonHDL was not involved in any included articles, the authors pointed out that the nonHDL value is TC minus HDL. A detailed formula of its mean and deviation or relative references would make the results more reliable. For the Quality Evaluation section, the NOS scores were inconsistent with the description in Risk of Bias and Quality Assessment. Table 2 demonstrates the inconsistent descriptions. For the Analysis Characteristics section, the incorrectly extracted information is shown in Table 1. For the Result section, some inconsistent descriptions are listed in Table 2. Moreover, SBP and WHR lacked sensitivity analysis in the Result section.
Table 2
| No | Section | Indicator | Quote A | Quote B |
|---|---|---|---|---|
| 1 | Quality Evaluation and Risk of Bias and Quality Assessment | NOS scores | In Table 3: 6 studies scored 8 points, 15 studies scored 7 points, 11 studies scored 6 points and 6 studies scored 5 points. | In Risk of Bias and Quality Assessment: only 1 article with 7 points, 1 article with 6 points, 3 articles with 4 points and below. |
| 2 | Statistical Analysis and Blood Pressure | SBP | In Figure 6: Alexandraki et al. (9) was included | In Table 2: Alexandraki et al. (9) did not included SBP |
| In Figure 6: Kargili et al. (11), Ketel et al. (4), Luque-Ramirez et al. (6) and Orio et al. (14) were included | In Table 2: Kargili et al. (11), Ketel et al. (4), Luque-Ramirez et al. (6) and Orio et al. (14) included SBP | |||
| 3 | DBP | In Figure 7: Alexandraki et al. (9) was included | In Table 2: Alexandraki et al. (9) did not include DBP | |
| In Figure 7: Kargili et al. (11), Luque-Ramirez et al. (6), Orio et al. (14) were not include | In Table 2: Kargili et al. (11), Luque-Ramirez et al. (6) and Orio et al. (14) included DBP |
Inconsistent information in the original review.
The Discussion section was relatively detailed and clear. However, according to the inclusion and exclusion criteria, there were some inappropriate articles included and some incomplete data. Furthermore, it is noted that during the discussion of lipid profiles, the change of HDL in different subgroups seems to be ignored.
This meta-analysis links PCOS, obesity, and cardiovascular risk factors, which have great clinical guiding value. However, due to some inappropriate information, an updated meta-analysis is needed to better draw conclusions and clarify the impact of BMI on cardiovascular risk factors in patients with PCOS with reliable methods. Additionally, more rigorous and standardized clinical research reports are an important premise for reasonable systematic reviews with meaningful conclusions.
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Statements
Author contributions
SL: design study, drafting the article, and making critical revisions. YK and KW: data collection, analysis, and drafting of the article. All authors contributed to the article and approved the submitted version.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
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Summary
Keywords
polycystic ovary syndrome, cardiovascular risk, reproductive age, body mass index, meta-analysis
Citation
Ke Y, Wu K and Liu S (2022) Commentary: Cardiovascular risk according to body mass index in women of reproductive age with polycystic ovary syndrome: A systematic review and meta-analysis. Front. Cardiovasc. Med. 9:920144. doi: 10.3389/fcvm.2022.920144
Received
14 April 2022
Accepted
19 July 2022
Published
10 August 2022
Volume
9 - 2022
Edited by
Dexter Canoy, University of Oxford, United Kingdom
Reviewed by
Helena Teede, Monash University, Australia
Updates
Copyright
© 2022 Ke, Wu and Liu.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Shan Liu graystar92@163.com
This article was submitted to Cardiovascular Epidemiology and Prevention, a section of the journal Frontiers in Cardiovascular Medicine
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.