Risk for heart, liver disease may vary between PCOS subtypes
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Key takeaways:
- Women with PCOS are more likely to develop type 2 diabetes and CVD than controls.
- Proton density fat fraction and liver corrected T1 levels were highest among women with hyperandrogenic PCOS.
Women with polycystic ovary syndrome and high androgen levels may have a higher risk for liver disease than those with PCOS and normal androgen levels, according to an analysis of UK Biobank data.
“We show that blood tests can identify different subtype of PCOS, and the risk of having heart disease, diabetes or liver disease may be different dependent on the subtype of PCOS somebody has,” Alex E. Henney, MBChb, MRes, academic clinical fellow in diabetes and endocrinology, and Daniel J. Cuthbertson, PhD, professor of diabetes and endocrinology at Aintree University Hospital, and University of Liverpool in the U.K., told Healio. “For example, postmenopausal people with PCOS who have high testosterone on their blood tests are more likely to have liver changes, but their risk of heart disease is similar to the general population. Conversely, postmenopausal people with PCOS who have normal testosterone have a higher chance of heart disease, but their risk of diabetes and liver changes is similar to the general population.”
Henney, Cuthbertson and colleagues obtained data from 1,008 women in the UK Biobank diagnosed with PCOS during a baseline assessment. Women with diagnoses or biochemical features for hyperandrogenism and secondary amenorrhea or oligomenorrhea were also included. Women with PCOS were matched by age and BMI with a control group of 5,017 women without PCOS. Prevalence of metabolic diseases, cardiovascular disease, cancer and dementia were collected at baseline. Incident diagnoses of type 2 diabetes, metabolic dysfunction-associated steatotic liver disease and CVD were obtained during follow-up. Researchers also assessed all-cause mortality and multi-organ MRI data at follow-up. A subgroup analysis stratified women with PCOS into a hyperandrogenic phenotype and a normoandrogenic phenotype. The hyperandrogenic PCOS group included women with a free androgen index of more than 5%.
Findings were published in The Journal of Clinical Endocrinology & Metabolism.
Diabetes, CVD more common with PCOS
At baseline, a higher percentage of women with PCOS had type 2 diabetes (7.3% vs. 4%), hypertension (26.6% vs. 19%), hepatocellular carcinoma (0.1% vs. 0%) and depression or anxiety (16.2% vs. 11.3%) than controls. No other differences in baseline disease prevalence were observed.
During follow-up, women with PCOS had higher risks for type 2 diabetes (adjusted HR = 1.47; 95% CI, 1.11-1.95) and CVD (aHR = 1.76; 95% CI, 1.35-2.3) than controls. No difference in risks for cancer, dementia or all-cause mortality was observed between the two groups.
Of those who underwent MRI, a higher proportion of women with PCOS had a proton density fat fraction of more than 5.5% (35.9% vs. 23.9%; P = .02) and higher corrected T1 levels (721.4 ms vs. 701.5 ms; P < .01) than women without PCOS.
Risk differences by PCOS subtype
In the subgroup analysis, 142 women were defined as having hyperandrogenic PCOS and 617 had normoandrogenic PCOS. Both groups were compared with a control group of 3,775 women without PCOS.
Women with normoandrogenic PCOS had higher CVD risk than women without PCOS (aHR = 1.9; 95% CI, 1.35-2.69). No associations were observed for type 2 diabetes, cancer or dementia.
Women with hyperandrogenic PCOS had higher proton density fat fraction (9% vs. 6%; P < .01) and greater corrected T1 levels (776.3 ms vs. 707.7 ms; P < .01) than those with normoandrogenic PCOS. The hyperandrogenic PCOS group also had higher proton density fat fraction (9% vs. 5.2%; P < .01) and corrected T1 (776.3 ms vs. 701.9 ms; P < .01) than the control group.
Henney and Cuthbertson said the findings show the importance of measuring testosterone for people with PCOS.
“In the U.K., the criteria used to diagnose PCOS say that testosterone levels are not needed for a diagnosis if other features, including changes to their ovaries on an ultrasound scan and irregular periods, are present, and therefore not everyone with PCOS will have accurate testosterone levels recorded,” Henney and Cuthbertson said. “Our study suggests that not knowing this information means we are not fully aware of the long-term complications of PCOS on an individual level. People living with PCOS may benefit from health checks throughout life, including being provided with lifestyle advice to help improve what they eat and their activity levels, in an attempt to lower the chance of developing heart disease, diabetes and liver disease.”
Henney and Cuthbertson said future studies should use liver tests to identify people with PCOS and early signs of liver disease and to assess the effects of GLP-1 medications and other new drugs on people with PCOS.
“In people with PCOS who are unable to maintain a healthy body weight with lifestyle changes alone, we are fortunate that new and effective medicines are being developed, including those that target hormones manufactured in the gut, that reduce the heart, kidney and liver disease, in people with diabetes and obesity,” Henney and Cuthbertson said. “How effective these drugs are patients with PCOS has not been proven. These is imperative to address now given the likely tsunami of liver disease in the future.”
For more information:
Daniel J. Cuthbertson, PhD, can be reached at dan.cuthbertson@liverpool.ac.uk.
Alex E. Henney, MBChb, MRes, can be reached at alexander.henney@liverpoolft.nhs.uk.
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