The Effect of Statins on Levels of Dehydroepiandrosterone (DHEA) in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Abstract

<strong>BACKGROUND</strong> Currently, statins are used to treat polycystic ovary syndrome (PCOS). This systematic review and meta-analysis aimed to investigate the effect of statins on serum or plasma levels of dehydroepiandrosterone (DHEA) in women with PCOS. <strong>MATERIAL AND METHODS</strong> Databases that were searched included PubMed, Embase, and the Cochrane Library from their inception to August of 2018. Published randomized controlled trials (RCTs) were identified that evaluated the impact of statins on plasma DHEA levels in women with PCOS. The Cochrane risk of bias tool was used to assess the quality of the included RCTs. A random-effects model was used to analyze the pooled results. <strong>RESULTS</strong> Meta-analysis was performed on data from ten published studies that included 735 patients and showed that statin treatment could significantly reduce plasma DHEA levels when compared with controls (SMD, -0.43; 95% CI, -0.81-0.06; p=0.02; I²=82%). Statins were significantly more effective than placebo in reducing the levels of DHEAs. Subgroup analysis based on statin type showed that atorvastatin significantly reduced DHEA levels (SMD, -0.63; 95% CI, -1.20 - -0.05; p=0.03; I²=38%) but simvastatin did not significantly reduce DHEA levels (SMD: -0.14; 95% CI, -0.49-0.28; p=0.43; I²=77%). Subgroup analysis based on duration of treatment showed no significant difference between 12 weeks of statin treatment (SMD, -0.61; 95% CI, -1.23-0.02; p=0.06; I²=85%) and 24 weeks (SMD, -0.34; 95% CI -0.95-0.28; p=0.29; I²=83%). <strong>CONCLUSIONS</strong> Meta-analysis showed that statins significantly reduced the levels of DHEA when compared with placebo in patients with PCOS.

Figure 1

Flowchart of the publication selection for meta-analysis. There were initially 127 publications identified, of which 105 were excluded. Of the 22 full-text publications that were reviewed, a further 12 were excluded due to incomplete data, duplication of reported studies, and irrelevant outcome data. There were ten studies included in the final meta-analysis.

Figure 2

Risk of bias.

Figure 3

Summary of risk of bias.

Figure 4

Forest plot of the effect of statins on the levels of dehydroepiandrosterone (DHEA). 95% CI – 95% confidence interval; SD – standard deviation.

Figure 5

Forest plot of the effect of statins on the levels of dehydroepiandrosterone (DHEA) using subgroup analysis of statin type. 95% CI – 95% confidence interval; SD – standard deviation.

Figure 6

Forest plot of the effect of statins on the levels of dehydroepiandrosterone (DHEA) using subgroup analysis of statin treatment duration. 95% CI – 95% confidence interval; SD – standard deviation.

Figure 7

Funnel plot of the studies included in the meta-analysis.