PCOS with diagnosed depression may signal greater cardiometabolic risk
Key takeaways:
- Polycystic ovary syndrome with diagnosed depression or anxiety was tied to metabolic syndrome risk.
- Clinicians should screen all women with PCOS for mental health conditions.
Women with polycystic ovary syndrome and a diagnosis of depression are 56% more likely to develop metabolic syndrome compared with women without depression, increasing their risk for type 2 diabetes and cardiovascular disease, data show.
Data show that a diabetes diagnosis is associated with diagnosed depression in the general population; however, whether there are associations between mental health and cardiometabolic conditions among patients with PCOS remains unknown, according to Anuja Dokras, MD, MHCI, PhD, professor of obstetrics and gynecology at the Hospital of the University of Pennsylvania and director of the Penn Polycystic Ovary Syndrome Center.
“We recognize that patients with PCOS are at increased risk for cardiometabolic risk factors — obesity, high blood pressure, prediabetes — and we have studied that in the form of metabolic syndrome,” Dokras told Healio. “The prevalence of metabolic syndrome is high among women with PCOS in their 20s and 30s. Metabolic syndrome tells us that as they get older, these women will be at increased risk for diabetes and heart disease, so it is a good marker. We have also shown a higher prevalence of depression and anxiety in young women with PCOS. What is the link between someone’s mental health and cardiometabolic health?”
For the retrospective study, Dokras and colleagues analyzed data from 321 women with hyperandrogenic PCOS evaluated at the Penn PCOS Center for metabolic syndrome during at least two visits 3 years apart. Researchers followed women for a median of 7 years (median age at first visit, 27 years). The primary outcome was risk for developing metabolic syndrome.
The findings were published in the Journal of Clinical Endocrinology and Metabolism.
At the first visit, 33% of women had a history of depression and/or anxiety, with one-third of women prescribed antidepressants or anxiolytics. The prevalence of metabolic syndrome at the first visit was 38.9%.
Women with a diagnosis of depression or anxiety were 45% more likely to be diagnosed with metabolic syndrome during follow-up (adjusted HR = 1.45; 95% CI, 1.02-2.06; P = .04) with an incidence 75.3 compared with 47.6 cases per 100 person-years among those without depression or anxiety (P = .002).
The association was primarily driven by depression (aHR = 1.56; 95% CI, 1.1-2.2; P = .01), according to Dokras.
“Clearly, the women that did not have a history of depression or anxiety or were not on medications [for depression or anxiety] had a lower risk for developing metabolic syndrome compared with those with one of these mental health conditions,” Dokras said during an interview. “We also found that depression was driving most of the increased risk for metabolic syndrome. We are not sure why, but it is in line with what we see in the general population with depression and diabetes. So the question is, is there something about depression that increases risk, or is it that a person with depression is perhaps not engaging as much in lifestyle behavior management?”
Dokas said the findings suggest that all women with PCOS should be screened during a baseline visit for depression and anxiety, as recommended in the two most recent international PCOS guidelines.
“We need to make all physicians aware that we need to screen women over time, because mental health is not static,” Dokras told Healio. “If a woman has depression, then we might want to be more aggressive in managing their cardiometabolic risk.”
For more information:
Anuja Dokras, MD, MHCI, PhD, can be reached at adokras@pennmedicine.upenn.edu; X (Twitter): @AnujaDokras.
