Does PCOS increase cardiovascular risk in women?
A strong association exists between polycystic ovarian syndrome (PCOS) and cardiovascular risk factors, but women with PCOS 40‒60 years of age are not at greater risk of cardiovascular morbidity and mortality, suggest the results of a study presented at the recent ESHRE 2023.
“Women with PCOS are at increased risk of developing adverse cardiometabolic outcomes including insulin resistance, type 2 diabetes (T2D), metabolic syndrome, hypertension, and dyslipidaemia,” said the researchers led by T Doulgeraki from the Royal London Hospital, Obstetrics and Gynaecology, London, United Kingdom.
“Those unfavourable risk factors would place women with PCOS at an increased risk for cardiovascular mortality and morbidity, [but] the evidence from epidemiological studies are so far heterogenous with conflicting results,” they added.
To address this, Doulgeraki and colleagues carried out this cohort study that included 75,142 participants from the UK biobank, of whom 15,747 had PCOS. Women were followed-up for a mean of 11.1 years.
Morbidity and mortality from ischaemic heart disease and stroke were the primary outcomes. Cox regression analysis, adjusted for confounders and risk factors, was performed to assess the risk of cardiovascular morbidity and mortality in women with PCOS.
Cardiovascular events occurred at a rate of 1.92 per 1,000 person-years in the PCOS population and 1.90 per 1,000 person-years in those without. [ESHRE 2023, abstract O-011]
PCOS significantly correlated with an increased likelihood of developing obesity (odds ratio [OR], 1.63, 95 percent confidence interval [CI], 1.56‒1.70), hypertension (OR, 1.18, 95 percent CI, 1.13‒1.23), and T2D (OR, 1.44, 95 percent CI, 1.31‒1.58).
However, in the adjusted Cox model, PCOS showed no significant association with a higher risk of cardiovascular morbidity and mortality (hazard ratio, 0.89, 95 percent CI, 0.78‒1.01). On the other hand, women aged >60 years and with a history of PCOS had a higher cumulative risk than those without.
“The strong association of PCOS with cardiometabolic risk factors and that the [cardiovascular] morbidity/mortality risk becomes comparable with that of women without PCOS after correcting for these factors highlights the need to strengthen public health strategies for surveillance, lifestyle interventions, and prompt treatment of those comorbidities in women with PCOS,” the researchers said.
Responder and reporting biases
The study, unfortunately, had a low response rate (5.5 percent) to the UK biobank recruitment, introducing a healthy responder bias that might have limited the representation of the population. In addition, PCOS was self-reported and assessed by clinical and biochemical features. Other variables were also self-reported; thus, reporting bias was a possibility.
“PCOS is one the [most common] endocrinopathies in women of reproductive age characterized by anovulation, hyperandrogenism, and polycystic ovaries in ultrasound surveillance,” the researchers said. “The prevalence of PCOS has been quoted 8 to 13 percent of women in the UK, [but] up to 70 percent of the cases may be undiagnosed.”