Medical Student Research Fellowship for Summer 2009

Mentor: Alice Y. Chang
Department: Internal Medicine/Endocrinology and Metabolism
Room number: U9.134H
Mail Code: 8857
Phone number: 214-648-2564
E-mail: alice.chang@utsouthwestern.edu
Project title: Coronary Atherosclerosis and Cardiovascular Performance in

Human subjects IRB approved project number (where applicable): IRB # 102007-007 and IRB #062007-040

Animal subjects IRB approved project number (where applicable):

Project Type: Patient-based research

Brief Description of Project:
Project 1: Coronary Atherosclerosis and Cardiovascular Performance in Polycystic Ovarian Syndrome
The global objective of this study is to determine if women with Polycystic Ovarian Syndrome (PCOS) have a greater burden of coronary atherosclerosis than women without PCOS using magnetic resonance imaging (MRI). Polycystic Ovarian Syndrome (PCOS) is a common disorder that occurs in 6-8% of women in the United States. PCOS is characterized by irregular menses, hirsutism and/or elevated circulating concentrations of testosterone, and an increased prevalence of metabolic risk factors for cardiovascular (CV) disease, including obesity, insulin resistance and dyslipidemia. Although it is generally assumed that women with PCOS are at increased risk for CV events, the evidence supporting this premise is weak. The overarching goal of the PI's research is to study the coronary atherosclerosis and exercise capacity of PCOS women to determine if they are at increased risk for CV disease. The primary objective of this project is to compare coronary macrovascular and microvascular function in response to the cold pressor test and the vasodilator adenosine between women with and without PCOS who are all at higher risk for cardiovascular disease secondary to insulin resistance. Secondary goals include characterization of differences in cardiovascular performance during an exercise test and assessment of the influence of testosterone concentrations and insulin sensitivity measured by the frequently sampled intravenous glucose tolerance test. A second funded project will evaluate the effects of 6 months exercise training in a subgroup of women with PCOS.

In the summer of 2009, the student will analyze initial correlations of insulin sensitivity, stress induced coronary flow and exercise performance in the first 10 to 15 participants studied. Initial findings will be compared to coronary flow data in overweight otherwise healthy women and women with diabetes. The student may also compare results from exercise performance testing to a group of overweight/obese otherwise healthy women previously tested at the Institute for Exercise and Environmental Medicine. The student will also participate in recruitment and data collection for additional participants and assist in the weekly follow-up of women in the 6 month exercise training program.

Project 2: Dyslipidemia in Women with Polycystic Ovarian Syndrome from Parkland Hospital
The objectives of this chart review are to: (1) determine the prevalence of dyslipidemia in women with PCOS in a Dallas County hospital cohort., (2) evaluate the differences among women with PCOS with dyslipidemia against a control group of women without PCOS from the Dallas Heart Study and (3) to examine the ethnic differences in dyslipidemia among women with PCOS. In analyzing the preliminary data collected during this study, we found that an ICD-9 search strategy at a county hospital could successfully identify patients with PCOS. The women with PCOS identified represent a severe phenotype with the majority meeting NIH consensus criteria and being morbidly obese. Most of these women with PCOS had an HDL level below 50. Second, ethnic differences in lipid profiles were seen among the PCOS women. Caucasian women with PCOS were more likely to have dyslipidemia, and African Americans were less likely to have abnormal TG or HDL. Interestingly, despite the known associations of PCOS with insulin resistance and CV risk, not all women with PCOS are getting fasting glucose or lipid panels. The goal for the summer will be to complete data collection and analysis in order to submit for publication.

Previous Research Activities or Publications with Medical Students:

2008-2009 Christopher Maroules, BS (MSIV). UT Southwestern. Measurement of Coronary Sinus Blood Flow using 3T MRI

He presented a poster at the local UT Southwestern Medical Student Research Forum (award winner) and the national Society of Cardiovascular Magnetic Resonance. He also presented an oral abstract at the Southern American Federation for Medical Research in New Orleans 2008 and received a travel award for this presentation.

Maroules, CD, Chang AY, Yadav H, Peshock RM. Measurement of Coronary Sinus Flow Reserve at 3-Tesla using Spiral Velocity-Encoded Cine MR Imaging in Response to Cold Pressor Stress: A Feasibility Study in At-Risk Women, under review, Journal Cardiovascular Magnetic Resonance Imaging.

Maroules CD, Yadav H, Peshock RM, Chang AY. Measurement of Impaired Coronary Vascular Reactivity using 3T MRI in Asymptomatic Women with Type 2 Diabetes. Oral abstract presentation, Southern Regional Meeting, American Federation for Medical Research, February 2009.

Chang AY, Kotys M, Dimitrov I, Kontak A, Yadav H, Maroules, CD, Tillery T, Peshock RM.
Coronary Artery Flow Velocity Reserve during the Cold Pressor Test in Overweight, Healthy Women using Spiral Imaging at 3T. Oral abstract presentation, Society for Cardiovascular Magnetic Resonance, January 2009.

Maroules, CD, Chang AY, Kontak A, Yadav H, Peshock RM. Coronary Sinus Flow Reserve in Response to Cold Pressor Stress in Healthy Women Using Velocity-Encoded Cine Spiral 3T MRI. Medical Student Research Symposium, January 2009.

In the summer of 2007, Alicia Jones, MS1, collected preliminary data for Project 2. She presented a poster at the UT Southwestern Medical Student Research Forum and an oral presentation to the Southern American Federation for Medical Research in New Orleans 2008.
Jones, A, Chang, AY. Dyslipidemia in Women with Polycystic Ovarian Syndrome from a County Hospital. Southern Regional Meeting, American Federation for Medical Research, February 2008.

Dr. Chang's has worked with 2 medical residents on case reports, one was presented as a poster at the Endocrine Society and one was published in 2008:

Sukumar S, Chang, AY, Welch, BJ, Kovacs, WJ, Wyne, KL. The Use of Labetalol in the Setting of Thyrotoxicosis and Cocaine-Induced Myocardial Infarction. Endo Suppl 2006;147 (298):Abst P2-877.

Patel R, Peterson G, Rohatgi A, Ghayee HK, Keeley EC, Auchus RJ, Chang AY. Hyperthyroidism-associated Coronary Vasospasm with Myocardial Infarction and Subsequent Euthyroid Angina. Thyroid. 2008; 18(2): 273-276.