This article is more than 5 years old. Information may no longer be current.
CVD screening vital for perimenopausal women with PCOS
Click Here to Manage Email Alerts
PHILADELPHIA — Polycystic ovary syndrome is associated with an increased risk for cardiovascular disease, and, therefore, women with the syndrome should be screened at a younger age than health women, according to a presenter at the Annual Meeting of the North American Menopause Society.
“The American of Obstetrics and Gynecology conducted a study that was published last year, where they asked, do you recognize PCOS as a cardiovascular risk condition and what is your screening pattern?” Anuja Dokras, MD, PhD, professor of obstetrics and gynecology at the University of Pennsylvania and director of PENN PCOS Program, said during her presentation. “Less than 10% of the respondents of the survey were performing oral glucose tolerance tests. If they didn’t do the oral glucose tolerance tests, the survey asked if they did the fasting glucose test, and less than 30% did that. Less than 20% performed lipid profiles. So, I think we’re at a stage where we just need to create an awareness of the syndrome and its risk associations more than the therapeutic status of the treatment.
CV risk factors in women with PCOS
Women with PCOS are at an increased risk for obesity (OR = 2.77; 95% CI, 1.88-4.1), even at an early age — as young as 15 years (20% compared with 3% to 4% of adolescents without PCOS), according to Dokras. Women with PCOS are also at an increased risk for impaired glucose tolerance (OR 2.48; 95% CI (1.63-3.77), gestational diabetes (OR 3.58; 95% CI, 3.05-4.2) and type 2 diabetes (OR = 4.43; 4.06-4.82). The diabetes risk is independent of age and BMI and is seen even in lean women (HR = 1.4), Dokras said.
When looking at composites of several smaller studies, PCOS is associated with increased carotid artery intima-media thickness, impaired endothelial function and coronary artery calcification, and these effects can been seen in women in their 20s or 30s, said Dokras.
“We have this high-risk group of women with PCOS, obesity, high androgens,” Dokras said. “They do have evidence of premature, subclinical atherosclerosis, evidence of type 2 diabetes, so one could almost hypothesize that this group is at high risk for cardiovascular events. That’s really the bottom line we’re interested in as they get older.”
Evidence of increased CVD
Determining CVD risk in women with PCOS is difficult because of lack of longitudinal data —the Rotterdam criteria, the current definition for diagnosing PCOS, were established only in 2004. Many studies have used presumed diagnosis, by measuring midlife androgens, to study CVD risk in women with PCOS.
(Hart et al. JCEM. 2015;doi: 10.1210/jc.2014-3886) analyzed data on 2,566 Australian women with PCOS and 25,660 controls without PCOS. This study found that PCOS was associated with an increased risk for hypertensive disorder, ischemic heart disease and cerebrovascular disease, even after controlling for obesity.
Studies have not shown that women with PCOS have an increased mortality risk, Dokras said.
CVD screening recommendations
Dokras, in conjunction with the Androgen Excess and Polycystic Ovary Syndrome Society, recommended screening for impaired glucose tolerance and type 2 diabetes using an oral glucose tolerance test every 2 to 5 years in women with PCOS. The researchers recommended compliling a fasting lipid profile every 2 years (or annually, if abnormal) to screen for dyslipidemia, and they recommended screening for obesity and hypertension at every visit.
“What I would urge everybody is to get screenings implemented, even though you may not be convinced about the increase risk of cardiovascular event,” Dokras said. “Most likely, the perimenopausal woman with PCOS that you are seeing today ... may have had no screening because she hasn’t visited too often or because PCOS has not been on their radar. If we could initiate screening, we would be one step closer to trying to counsel these patients.” by Cassie Homer
Reference:
Dokras A, et al. Polycystic Ovary Syndrome—Is the Cardiometabolic Risk Increased After Menopause; Oct. 11-14, 2017; Philadelphia, Pa.
Disclosure: Dokras reports she is a consultant for Fractyl.