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No increased CVD risk observed in PCOS
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Women with polycystic ovary syndrome are at higher risk for obesity and elevated cholesterol vs. healthy women, but researchers observed no increased prevalence of cardiovascular disease in this population, according to findings published in Diabetes/Metabolism Research and Reviews.
“In spite of the fact that already in the ’90s, it was hypothesized that PCOS patients would have increased prevalence of CV morbidity and mortality, an increased risk of CVD is still debated,” Magorzata Jacewicz-wicka, MD, of the department of endocrinology, diabetology and internal medicine, Medical University of Bialystok, Poland, and colleagues wrote. “In the 21st century, authors still emphasized that long-lasting metabolic dysfunction in women with PCOS could exaggerate CVD risk and probably lead to an increase in CV events with age, especially after menopause.”
Jacewicz-wicka and colleagues reviewed data from 47 longitudinal studies published between 1992 and 2018 that examined metabolic and CVD complications, with follow-up observations, in women with PCOS. The studies’ primary outcomes were BMI; presence of metabolic syndrome and its components (waist circumference, lipid profile, arterial hypertension, abnormal glucose metabolism, impaired fasting glucose, type 2 diabetes); insulin resistance; and CVD, such as stroke, angina and coronary heart disease.
The researchers found that two studies from Italy and Finland identified a progressive and significant increase in waist circumference and a significantly higher waist circumference, respectively, in women with PCOS vs. controls. In contrast, studies from Iran and Sweden identified no significant changes in waist circumference over time among women with PCOS or controls. Women with PCOS were found to have a significantly higher waist-to-hip ratio vs. controls in several studies, but not all. A population-based cohort study found that obesity was significantly more prevalent in women with PCOS vs. controls (16% vs. 3.7%). A recently published prospective population-based study found that weight gain was significantly greater in patients with PCOS vs. controls, and PCOS was significantly linked to BMI at all ages analyzed.
In terms of lipids, study findings varied. One study found that PCOS was correlated with a twofold higher odds of dyslipidemia over 18 years, regardless of BMI. A significant increase in LDL over 21 years in women with PCOS was observed in another study, and a significant increase in total cholesterol, LDL and non-HDL was seen in women with PCOS in a study with 20 years of follow-up. Another study found no significant changes in lipid levels among women with PCOS over 10 years.
CV findings among women with PCOS were also mixed. In one large retrospective study, researchers found that women with PCOS did not differ in overall CVD mortality vs. the U.K. national average. Moreover, prospective research with more than 20 years of follow-up showed no significant difference in the overall CVD mortality among women with PCOS who had undergone ovarian resection vs. controls. In a retrospective observational study, the RR of all-cause mortality and large vessel disease was not significantly different in women with PCOS vs. controls. However, another study found a twofold increase in reports of CVD in women with diagnosed metabolic syndrome vs. those without metabolic syndrome (9.5% vs. 4%). In one analysis, which excluded arterial hypertension and dyslipidemia, the estimated incidence of CVD was 6.4 per 1,000 person-years in the PCOS group and 4.5 in controls, which was statistically significant.
“It appears that the PCOS women have increased tendency of obesity, abdominal fat distribution, dyslipidemia and deterioration of glucose metabolism compared to the healthy women,” the researchers wrote. “However, data about higher prevalence of [arterial hypertension] in PCOS seem to be unconvincing. Furthermore, although CV risk is clearly increased in young patients with PCOS, authors of most of the cited publications did not find significant excess of CVD prevalence, meaning both CHD and [cerebrovascular disease] morbidity or mortality in PCOS women.” – by Jennifer Byrne
Disclosures: The authors report no relevant financial disclosures.
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