PCOS associated with increased mortality risk
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CHICAGO — Women with polycystic ovary syndrome may have an increased mortality risk, particularly death due to cardiovascular disease and diabetes, compared with those without PCOS, according to a study presented at ENDO 2023.
Terhi T. Piltonen, MD, PhD, a consultant in obstetrics and gynecology at the University of Oulu and Oulu University Hospital in Finland, said the findings revealed the importance of monitoring all areas of health for women with PCOS.
“I think we need to acknowledge [PCOS] is a health burden,” Piltonen said during a press conference. “It’s not just a reproductive problem.”
Piltonen and colleagues analyzed data from 9,839 people with PCOS and 70,705 controls, matched by year of birth and area of residency, identified through the Finnish Care Register for Health Care from 1969 to 2019 using ICD codes. During follow-up, 1,003 controls and 177 people with PCOS died.
The researchers found that adults with PCOS had an increased overall mortality compared with controls in both an unadjusted (HR = 1.53; 95% CI, 1.28-1.84) and adjusted (HR = 1.47; 95% CI, 1.23-1.76) analyses.
More specifically, in the unadjusted analysis, adults with PCOS had increased mortality due to tumors (HR = 1.42; 95% CI, 1.06-1.9), endocrine, nutrition or metabolic diseases (HR = 2.45; 95% CI, 1.02-5.96) and diseases of the circulatory system (HR = 1.77; 95% CI, 1.19-2.62).
In the adjusted analysis, adults with PCOS had an increased mortality due to diseases of the circulatory system (aHR = 1.67; 95% CI, 1.13-2.48) and tumors (aHR = 1.38; 95% CI, 1.04-1.85). Adults with PCOS also had increased mortality due to diabetes (aHR = 3.07; 95% CI, 1.16-8.08), other diseases of the circulatory system (aHR = 2.07; 95% CI, 1-4.25) and bronchitis (aHR = 3.61; 95% CI, 1.01-12.88).
“Women with PCOS seem to be having increased mortality due to diseases of the circulatory system as well as cancer and diabetes,” Piltonen said. “The strength of this study was matched controls by age as well as place of birth, as well as the data was adjusted for education.”
During the question and answer portion of the press conference, Piltonen said health care providers need to focus more on improving the overall health of women with PCOS beyond reproductive concerns. She called for multidisciplinary collaboration between providers in treating women with PCOS and more funding for PCOS research.
Perspective
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Polycystic ovary syndrome is the most common endocrine-metabolic disorder of women, affecting between 10% and 15% of all women worldwide. It is associated with increased risk for metabolic, cardiovascular, mental health, dermatologic and reproductive disorders, and significantly impacts quality of life. In the U.S. alone, it is estimated to result in $15 billion in additional healthcare-related economic costs annually.
Although it is a lifelong disorder, signs and symptoms are clinically most evident during the reproductive years. While we are aware that PCOS leads to increased risks for various morbidities, including type 2 diabetes, metabolic syndrome, cardiovascular disease and stroke, anxiety, depression, eating disorders and endometrial cancer, the impact of the disorder on overall mortality is still unclear. The study by Piltonen and colleagues is important in that it confirms the association of PCOS with mortality at an early age, which has been difficult to demonstrate.
While an important contribution, the risk observed in this study may actually be underestimated, as the study identified women with PCOS using specific codes within the Finnish Care Register for Health Care and we know that PCOS is significantly underdiagnosed in health care systems. The observation that mortality is increased in PCOS women, even at a young age, requires further study and confirmation, considering the very high prevalence of the disorder globally.
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Ollila MM, et al. OR35. Presented at: ENDO Annual Meeting; June 15-18, 2023; Chicago.
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