Women with PCOS show increased CVD risk factors

Issue: June 2011

13th European Congress of Endocrinology

Women with polycystic ovary syndrome appear to have higher serum concentrations of cardiovascular disease risk factors compared with women without the syndrome.

Previous research has not shown a definite link between PCOS and CVD risk markers, so researchers at Aristotle University of Thessaloniki, Greece, conducted a meta-analysis and review of the best available evidence and data. The analysis included 130 studies, involving 6,620 women with PCOS and 4,546 controls.

“This meta-analysis of biochemical markers shows that the CVD risk factors are present in earlier life, and that they seem to be independent of other factors, which can lead to cardiovascular disease in later life, such as obesity,” Konstantinos Toulis, MD, MSc, said in a press release.

The researchers tested 10 biochemical blood markers for CVD, including C-reactive protein, homocysteine and plasminogen activator inhibitor-1 antigen. According to the results, seven of the 10 markers were significantly elevated in women with PCOS:

C-reactive protein.
Homocysteine.
PAI-1 antigen.
PAI-1 activity.
VEGF.
Asymmetric dimethylarginine.
Advanced glycation end products.

Tumor-necrosis factor-alpha and fibrinogen levels were raised, but they were of borderline significance. The researchers found a nonsignificant result in levels of interleukin-6.

“The association between CVD risk and CVD markers depends on the nature of the individual marker and the magnitude of difference; this, plus the fact that there are several of these biochemical markers raised, is what makes this a potential warning,” Toulis said in the release.

The researchers said, however, that the link between the biochemical markers and CVD risk in women with PCOS is just an association — not cause and effect.

“We need to follow this up by looking at women with PCOS and CVD, and seeing if they had shown higher levels of the risk markers,” Toulis said.

For more information:

Toulis K. Abstract 26 P99. Presented at: 13th European Congress of Endocrinology; April 30-May 4, 2011; Rotterdam, the Netherlands.

PCOS has been associated with an increased risk for CVD as evidenced by not only biochemical parameters but also vascular imaging techniques in several clinical investigations over several years. Therefore, a meta-analysis of these studies to accumulate the intelligence gathered to date is invaluable. Although these findings are intriguing, the challenges in interpreting these findings include understanding more about the PCOS populations; for example, obesity (as the researchers mentioned), menopausal status, and age, which may affect the CVD risk markers. In addition, ensuring that PCOS was defined uniformly across the studies, or at least identifying the ways in which PCOS was defined, will facilitate understanding the impact for all PCOS women. The researchers' suggestion to follow-up this investigation with a clinical study would enhance our appreciation of the findings. Moreover, a longitudinal and/or population study would be an ideal step to determine the clinical significance of these results.

– Rhonda M. Bentley-Lewis, MD, MBA, MMSc

Instructor in Medicine
Harvard Medical School

Disclosure: Dr. Bentley-Lewis reports no relevant financial disclosures.

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