Diabetes and Cardiovascular Events in Women With PCOS
Diabetes and Cardiovascular Events in Women With PCOS
Objective Women with polycystic ovary syndrome (PCOS) are potentially at increased risk of cardiovascular (CV) diseases due to well-established risk factors, including insulin resistance, obesity and type 2 diabetes mellitus (T2DM). However, data showing excess CV events in this population are still lacking. We investigated the incidence and prevalence of CV events in a cohort of women with PCOS.
Design Retrospective cohort study (total follow-up >12 000 person-years).
Setting Leicester, Leicestershire and Rutland (Total Female population of 434 859), UK.
Participants Two thousand three hundred and one women with PCOS (mean age = 29·6 years) attending a speciality clinic in Leicestershire, UK.
Main outcomes measures
T2DM, myocardial infarction (MI), angina, heart failure (HF), stroke and CV-related death.
Results Incidence of T2DM, MI, angina, HF, stroke and CV death was respectively 3·6, 0·8, 1·0, 0·3, 0·0 and 0·4 per 1000 person-years. At the end of follow-up, the prevalence of MI in the age groups 45–54, 55–64 and >65 years was 1·9%, 6·0% and 27·3% and of angina was 2·6%, 6·0% and 27·3%, respectively. Age-group-specific odds ratios for the prevalence of MI and angina compared to the local female population ranged between 2·6 (95% CI: 1·0–6·3) and 12·9 (CI: 3·4–48·6) with the highest ratio being for MI in the group >65 years old. Age, history of hypertension and smoking had significant correlations with CV outcomes in the PCOS patients.
Conclusion We have shown a high incidence and age-group-specific prevalence of T2DM, MI and angina in the women with PCOS, with over a quarter having had MI or angina in those >65 years. These findings should be considered in the treatment strategies and long-term planning for women with PCOS.
Polycystic ovary syndrome (PCOS) is one of the most common endocrine abnormalities in women with a reported prevalence of 8–12% depending on which diagnostic criteria are used. It is also the most common cause of oligo-anovulatory infertility.
Evidence suggests that women with PCOS might be at increased risk of cardiovascular (CV) disease. About 50–70% of women with PCOS have been shown to have insulin resistance and may therefore share the known CV risk of patients with metabolic syndrome and type 2 diabetes mellitus (T2DM). They also have been reported to have a high prevalence of impaired glucose regulation and T2DM of 40% and 10%, respectively. Furthermore, 50–70% of women with PCOS are reported to be overweight or obese. Biomarkers associated with an increased risk of CV disease such as C-reactive protein, homocysteine and tumour necrosis factor (TNF-α) have also shown to be increased in women with PCOS.
Despite PCOS being associated with these well-established risk factors for CV disease, published data to date have not confirmed a link with hard CV outcomes. PCOS is the most common cause of unexplained oligo-amenorrhoea, and studies have reported a significant correlation of menstrual dys-regulation with CV disease even after adjustment for body mass index (BMI) and other confounders. In addition, women with menstrual irregularity have a higher prevalence of angiographic abnormalities; however, PCOS patients in Dallas Heart Study did not have a higher rate of coronary artery calcification. A long-term retrospective cohort study reported no differences in myocardial infarction (MI) and angina but increased rate of stroke and no increased CV mortality. A recent retrospective study from the Netherlands also reported no increase in CV morbidity and mortality. However, a meta-analysis showed a twofold increase in risk of arterial disease irrespective of BMI in this patient population compared to general population.
Our aim was to determine the prevalence and incidence of T2DM and CV diseases in women with PCOS using a large regional nonselective clinical database.
Abstract and Introduction
Abstract
Objective Women with polycystic ovary syndrome (PCOS) are potentially at increased risk of cardiovascular (CV) diseases due to well-established risk factors, including insulin resistance, obesity and type 2 diabetes mellitus (T2DM). However, data showing excess CV events in this population are still lacking. We investigated the incidence and prevalence of CV events in a cohort of women with PCOS.
Design Retrospective cohort study (total follow-up >12 000 person-years).
Setting Leicester, Leicestershire and Rutland (Total Female population of 434 859), UK.
Participants Two thousand three hundred and one women with PCOS (mean age = 29·6 years) attending a speciality clinic in Leicestershire, UK.
Main outcomes measures
T2DM, myocardial infarction (MI), angina, heart failure (HF), stroke and CV-related death.
Results Incidence of T2DM, MI, angina, HF, stroke and CV death was respectively 3·6, 0·8, 1·0, 0·3, 0·0 and 0·4 per 1000 person-years. At the end of follow-up, the prevalence of MI in the age groups 45–54, 55–64 and >65 years was 1·9%, 6·0% and 27·3% and of angina was 2·6%, 6·0% and 27·3%, respectively. Age-group-specific odds ratios for the prevalence of MI and angina compared to the local female population ranged between 2·6 (95% CI: 1·0–6·3) and 12·9 (CI: 3·4–48·6) with the highest ratio being for MI in the group >65 years old. Age, history of hypertension and smoking had significant correlations with CV outcomes in the PCOS patients.
Conclusion We have shown a high incidence and age-group-specific prevalence of T2DM, MI and angina in the women with PCOS, with over a quarter having had MI or angina in those >65 years. These findings should be considered in the treatment strategies and long-term planning for women with PCOS.
Introduction
Polycystic ovary syndrome (PCOS) is one of the most common endocrine abnormalities in women with a reported prevalence of 8–12% depending on which diagnostic criteria are used. It is also the most common cause of oligo-anovulatory infertility.
Evidence suggests that women with PCOS might be at increased risk of cardiovascular (CV) disease. About 50–70% of women with PCOS have been shown to have insulin resistance and may therefore share the known CV risk of patients with metabolic syndrome and type 2 diabetes mellitus (T2DM). They also have been reported to have a high prevalence of impaired glucose regulation and T2DM of 40% and 10%, respectively. Furthermore, 50–70% of women with PCOS are reported to be overweight or obese. Biomarkers associated with an increased risk of CV disease such as C-reactive protein, homocysteine and tumour necrosis factor (TNF-α) have also shown to be increased in women with PCOS.
Despite PCOS being associated with these well-established risk factors for CV disease, published data to date have not confirmed a link with hard CV outcomes. PCOS is the most common cause of unexplained oligo-amenorrhoea, and studies have reported a significant correlation of menstrual dys-regulation with CV disease even after adjustment for body mass index (BMI) and other confounders. In addition, women with menstrual irregularity have a higher prevalence of angiographic abnormalities; however, PCOS patients in Dallas Heart Study did not have a higher rate of coronary artery calcification. A long-term retrospective cohort study reported no differences in myocardial infarction (MI) and angina but increased rate of stroke and no increased CV mortality. A recent retrospective study from the Netherlands also reported no increase in CV morbidity and mortality. However, a meta-analysis showed a twofold increase in risk of arterial disease irrespective of BMI in this patient population compared to general population.
Our aim was to determine the prevalence and incidence of T2DM and CV diseases in women with PCOS using a large regional nonselective clinical database.