Polycystic ovary syndrome: a “risk-enhancing” factor for cardiovascular disease

Patients with polycystic ovary syndrome are at elevated cardiovascular risk attributed to underlying metabolic dysfunction, for which lifestyle management and pharmacotherapy as indicated can mitigate this risk.
Polycystic ovary syndrome: a “risk-enhancing” factor for cardiovascular disease

VOLUME 117, ISSUE 5, P924-935

Authors:

Carolyn Guan, B.A., Salman Zahid, M.D., Anum S. Minhas, M.D., MHS, Pamela Ouyang, MBBS, Arthur Vaught, M.D., Valerie L. Baker, M.D., Erin D. Michos, M.D., M.H.S. 

Abstract:

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age and is hallmarked by hyperandrogenism, oligo-ovulation, and polycystic ovarian morphology. Polycystic ovary syndrome, particularly the hyperandrogenism phenotype, is associated with several cardiometabolic abnormalities, including obesity, dyslipidemia, elevated blood pressure, and prediabetes or type 2 diabetes. Many, but not all, studies have suggested that PCOS is associated with increased risk of cardiovascular disease (CVD), including coronary heart disease and stroke, independent of body mass index and traditional risk factors. Interpretation of the data from these observational studies is limited by the varying definitions and ascertainment of PCOS and CVD across studies. Recent Mendelian randomization studies have challenged the causality of PCOS with coronary heart disease and stroke. Future longitudinal studies with clearly defined PCOS criteria and newer genetic methodologies may help to determine association and causality. Nevertheless, CVD risk screening remains critical in this patient population, as improvements in metabolic profile and reduction in CVD risk are achievable with a combination of lifestyle management and pharmacotherapy. Statin therapy should be implemented in women with PCOS who have elevated atherosclerotic CVD risk. If CVD risk is uncertain, measurement of subclinical atherosclerosis (carotid plaque or coronary artery calcium) may be a useful tool to guide shared decision-making about initiation of statin therapy. Other medications, such as metformin and glucagon-like peptide-1 receptor agonists, also may be useful in reducing CVD risk in insulin-resistant populations. Additional research is needed to determine the best pathways to mitigate PCOS-associated CVD risk.

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Comments

Go to the profile of Pandiyan  Natarajan
3 months ago
Excessive weight causes PCOS and enhances Risk of Cardiovascular disease. PCOS is an Epiphenomenon. The primary problem in PCOS is Excessive non physiological weight gain. This leads to Anovulation and if left untreated progresses to PCOS. Cardio Vascular disease in PCOS is primarily due to the Excessive non physiological  weight gain . Excessive Weight gain also leads to Type 2 Diabetes Mellitus in a significant proportion of patients.  Please find enclosed link to our articles on PCOS. This may be of  interest to the readers. 1) Prevalence of Glucose Tolerance Test abnormalities in South Indian Sub-fertile PCOS women  https://www.chcmj.ac.in/pdf/vol4_no1/Prevalence.pdf 2) Polycystic Ovary Syndrome is an Epiphenomenon - An Opinion https://www.chcmj.ac.in/pdf/vol5_no3/polycystic_ovary.pdf 3) Is Weight Gain the Precipitating Factor for Polycystic Ovarian Syndrome? A Hypothesis Based on a Retrospective Study. https://www.chcmj.ac.in/pdf/vol4_no3/Is_Weight_Gain.pdf 4) Pregnancy Complications - Consequence of Polycystic Ovary Syndrome or Body Mass Index? https://www.chcmj.ac.in/pdf/vol6_no1/pregnancy.pdf Professor Dr Pandiyan Natarajan, Chief Consultant in Andrology and Reproductive Sciences, Apollo 24/7, NOVA IVF FERTILITY, Chettinad Super Speciality Hospital (Retired)