Semin Reprod Med 2008; 26(1): 039-044
DOI: 10.1055/s-2007-992923
© Thieme Medical Publishers

Cardiovascular Disease Risk Factors in Polycystic Ovary Syndrome

Anuja Dokras1
  • 1Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa; Current affiliation: Penn Fertility Care, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
08 January 2008 (online)

ABSTRACT

Polycystic ovary syndrome (PCOS) is a common endocrinopathy associated with an increasing number of cardiovascular comorbidities. The relationship between insulin resistance and PCOS was described more than 3 decades ago. Women with PCOS also have an increased prevalence of several established cardiovascular risk factors such as diabetes, hypertension, and dyslipidemia. These factors contribute to the increased risk of endothelial dysfunction, increased carotid artery intima media thickness, and coronary artery calcification noted in women with PCOS compared with controls. Although truncal obesity is very prevalent in PCOS, these surrogate markers of atherosclerosis have been shown to be independent of body weight in young, asymptomatic subjects. Metabolic syndrome is a cluster of risk factors that also confer an increased risk of cardiovascular disease. Women with PCOS have also been shown to have a significantly higher prevalence of metabolic syndrome compared with age-matched controls. Currently, there are no longitudinal studies confirming increased cardiovascular morbidity and/or mortality in women with PCOS. However, the early presence of traditional and other cardiovascular risk factors underscores the need to screen and aggressively counsel and treat these women to prevent future symptomatic cardiovascular disease.

REFERENCES

  • 1 Knochenhauser E S, Key T J, Kahser-Miller M, Waggoner W, Boots L R, Aziz R. Prevalence of polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study.  J Clin Endocrinol Metab. 1998;  83 3078-3082
  • 2 Dunaif A, Givens J R, Haseltine F P, Merriam G R. Current Issues in Endocrinology and Metabolism, Polycystic Ovary Syndrome. Boston, MA; Blackwell Scientific 1992
  • 3 The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group . Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.  Fertil Steril. 2004;  81 19-25
  • 4 Dahlgren E, Janson P O, Johansson S, Lapidus L, Oden A. Polycystic ovary syndrome and risk for myocardial infarction-evaluated from a risk factor model based on a prospective study of women.  Acta Obstet Gynecol Scand. 1992;  71 599-604
  • 5 Legro R S, Kunselman A R, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome.  Am J Med. 2001;  111 607-613
  • 6 Dokras A, Bochner M, Hollinrake E, Markham S, Vanvoorhis B, Jagasia D H. Screening women with polycystic ovary syndrome for metabolic syndrome.  Obstet Gynecol. 2005;  106 131-137
  • 7 Legro R S, Kunselman A R, Dodson W C, Dunaif A. Prevalence and predictors of risk for type II diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective controlled study in 254 affected women.  J Clin Endocrinol Metab. 1999;  84 165-169
  • 8 Heron M P, Smith B L. Deaths: leading causes for 2003.  Natl Vital Stat Rep. 2007;  55 1-92
  • 9 Birdsall M A, Farquhar C M, White H D. Association between polycystic ovaries and extent of coronary artery disease in women having cardiac catheterization.  Ann Intern Med. 1997;  126 32-35
  • 10 Solomon C G, Hu F B, Dunaif A et al.. Menstrual cycle irregularity and risk for future cardiovascular disease.  J Clin Endocrinol Metab. 2002;  87 2013-2017
  • 11 Lo J C, Feigenbaum S L, Yang J, Pressman A R, Selby J V, Go A S. Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome.  J Clin Endocrinol Metab. 2006;  91 1357-1363
  • 12 Ehrmann D A, Kasza K, Azziz R, Legro R S, Ghazzi M N. for the PCOS/Troglitazone Study Group . Effects of race and family history of type 2 diabetes on metabolic status of women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2005;  90 66-71
  • 13 Legro R S, Gnatuk C L, Kunselman A R, Dunaif A. Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study.  J Clin Endocrinol Metab. 2005;  90 3236-3242
  • 14 Palmert M R, Gordon C M, Kartashov A I, Legro R S, Emans S J, Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2002;  87 1017-1023
  • 15 Wild R A, Painter P C, Coulson P B, Carruth K B, Ranney G B. Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 1985;  61 946-951
  • 16 Gaziano J M, Hennekens C H, O'Donnell C J, Breslow J L, Buring J E. Fasting triblycerides, high-density lipoprotein, and risk of myocardial infarction.  Circulation. 1997;  96 2520-2525
  • 17 Maruyama C, Imamura K, Teramoto T. Assessment of LDL particle size by triglyceride/HDL-cholesterol ratio in non-diabetic, healthy subjects without prominent hyperlipidemia.  J Atheroscler Thromb. 2003;  10 186-191
  • 18 McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers identify overweight individuals who are insulin-resistant.  Ann Intern Med. 2003;  139 802-809
  • 19 Brehm A, Pfeiler G, Pacini G, Vierhapper H, Roden M. Relationship between serum lipoprotein ratios and insulin resistance in obesity.  Clin Chem. 2004;  50 2316-2322
  • 20 McLaughlin T, Reaven G, Abbasi F et al.. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease?.  Am J Cardiol. 2005;  96 399-404
  • 21 Chobanian A V, Bakris G L, Black H R for the National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure et al. National High Blood Pressure Education Program Coordinating Committee. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report.  JAMA. 2003;  289 2560-2572
  • 22 Holte J, Gennarelli G, Berne C, Bergh T, Lithell H. Elevated ambulatory day-time blood pressure in women with polycystic ovary syndrome: a sign of a pre-hypertensive state?.  Hum Reprod. 1996;  11 23-28
  • 23 Chen M J, Yang W S, Yang J H, Chen C L, Ho H N, Yang Y S. Relationship between androgen levels and blood pressure in young women with polycystic ovary syndrome.  Hypertension. 2007;  49 1442-1447
  • 24 Haffner S M, Valdez R A, Hazuda H P, Mitchell B D, Morales P A, Stern M P. Prospective analysis of the insulin-resistance syndrome (syndrome X).  Diabetes. 1992;  41 715-722
  • 25 National Institutes of Health .Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). NIH Publication 01-3670. Bethesda, MD; National Institutes of Health 2001
  • 26 Grundy S M, Cleeman J I, Daniels S R et al.. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, Blood Institute Scientific Statement.  Circulation. 2005;  112 2735-2752
  • 27 Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women.  Arch Intern Med. 2004;  164 1066-1076
  • 28 Talbott E O, Zborowski J V, Rager J R, Boudreaux M Y, Edmundowicz D A, Guzick D S. Evidence for an association between metabolic cardiovascular syndrome and coronary and aortic calcification among women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2004;  89 5454-5461
  • 29 Ehrmann D A, Liljenquist D R, Kasza K, Azziz R, Legro R S, Ghazzi M N. for the PCOS/Troglitazone Study Group . Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2006;  91 48-53
  • 30 Ford E S, Giles W H, Dietz W H. Prevalence of metabolic syndrome among US adults.  JAMA. 2002;  287 356-359
  • 31 Perticone F, Ceravolo R, Pujia A et al.. Prognostic significance of endothelial dysfunction in hypertensive patients.  Circulation. 2001;  104 191-196
  • 32 Heitzer T, Schlinzig T, Krohn K, Meinertz T, Munzel T. Endothelial dysfunction, oxidative stress, and risk of cardiovascular events in patients with coronary artery disease.  Circulation. 2001;  104 2673-2678
  • 33 Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990's.  Nature. 1993;  362 801-809
  • 34 Steinberg H O, Chaker H, Leaming R, Johnson A, Brechtel G, Baron A D. Obesity/insulin resistance is associated with endothelial dysfunction - implications for the development of insulin resistance.  J Clin Invest. 1996;  97 2601-2610
  • 35 Orio Jr F, Palomba S, Cascella T et al.. Early impairment of endothelial structure and function in young normal-weight women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2004;  89 4588-4593
  • 36 Tarkun I, Arslan B C, Canturk Z, Turemen E, Sahin T, Duman C. Endothelial dysfunction in young women with polycystic ovary syndrome: relationship with insulin resistance and low-grade chronic inflammation.  J Clin Endocrinol Metab. 2004;  89 5592-5596
  • 37 Dokras A, Jagasia D H, Maifeld M, Sinkey C A, VanVoorhis B J, Haynes W G. Obesity/insulin resistance but not hyperandrogenism is an important mediator of vascular dysfunction in women with PCOS.  Fertil Steril. 2006;  86 1702-1709
  • 38 Paradisi G, Steinberg H O, Hempfling A et al.. Polycystic ovary syndrome is associated with endothelial dysfunction.  Circulation. 2001;  103 1410-1415
  • 39 Mather K J, Verma S, Corenblum B, Anderson T J. Normal endothelial function despite insulin resistance in healthy women with the polycystic ovary syndrome.  J Clin Endocrinol Metab. 2000;  85 1851-1856
  • 40 Bickerton A ST, Clark N, Meeking D et al.. Cardiovascular risk in women with polycystic ovary syndrome (PCOS).  J Clin Pathol.. 2005;  58 151-154
  • 41 Bots M L, Baldassarre D, Simon A et al.. Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations?.  Eur Heart J. 2007;  28 398-406
  • 42 Talbott E O, Guzick D S, Sutton-Tyrell K et al.. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women.  Arterioscler Thromb Vasc Biol. 2000;  20 2414-2421
  • 43 Carmina E, Orio F, Palomba S et al.. Endothelial dysfunction in PCOS: role of obesity and adipose hormones.  Am J Med. 2006;  119 356.e1-6
  • 44 Talbott E O, Zborowski J V, Boudreaux M Y, McHugh-Pemu K P, Sutton-Tyrrell K, Guzick D S. The relationship between C-reactive protein and carotid intima-media wall thickness in middle-aged women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2004;  89 6061-6067
  • 45 Agatston A S, Janowitz W R, Hildner F J, Zusmer N R, Viamonte M, Detrano R. Quantification of coronary calcium using ultrafast computed tomography.  J Am Coll Cardiol. 1990;  15 827-832
  • 46 Arad Y, Spadaro L A, Goodman K, Newstein D, Guerci A D. Prediction of coronary events with electron beam computed tomography.  J Am Coll Cardiol. 2000;  36 1253-1260
  • 47 Christian R C, Dumesic D A, Behrenbeck T, Oberg A L, Sheedy II P F, Fitzpatrick L A. Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2003;  88 2562-2568
  • 48 Shroff R, Kirschner A, Maifeld M, Van Beek E, Jagasia D, Dokras A. Young obese women with polycystic ovary syndrome have evidence of early coronary atherosclerosis.  J Clin Endocrinol Metab. 2007 Sep 11;  , [Epub ahead of print]
  • 49 Mahoney L T, Burns T L, Stanford W et al.. Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study.  J Am Coll Cardiol. 1996;  27 277-284
  • 50 Tsimikas S, Willerson J T, Ridker P M. C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients.  J Am Coll Cardiol. 2006;  47 C19-C31
  • 51 Kelly C C, Lyall H, Petrie J R, Gould G W, Connell J M, Sattar N. Low grade chronic inflammation in women with polycystic ovarian syndrome.  J Clin Endocrinol Metab. 2001;  86 2453-2455
  • 52 Weisberg S P, McCann D, Desai M, Rosenbaum M, Leibel R L, Ferrante Jr A W. Obesity is associated with macrophage accumulation in adipose tissue.  J Clin Invest. 2003;  112 1796-1808
  • 53 Mohlig M, Spranger J, Osterhoff M et al.. The polycystic ovary syndrome per se is not associated with increased chronic inflammation.  Eur J Endocrinol. 2004;  150 525-532
  • 54 Boulman N, Levy Y, Leiba R et al.. Increased C-reactive protein levels in the polycystic ovary syndrome: a marker of cardiovascular disease.  J Clin Endocrinol Metab. 2004;  89 2160-2165
  • 55 Puder J J, Varga S, Kraenzlin M, De Geyter C, Keller U, Muller B. Central fat excess in polycystic ovary syndrome: relation to low-grade inflammation and insulin resistance.  J Clin Endocrinol Metab. 2005;  90 6014-6021
  • 56 Olszanecka-Glinianowicz M, Banas M, Zahorska-Markiewicz B et al.. Is the polycystic ovary syndrome associated with chronic inflammation per se?.  Eur J Obstet Gynecol Reprod Biol. 2007;  133 197-202
  • 57 Vgontzas A N, Trakada G, Bixler E O et al.. Plasma interleukin 6 levels are elevated in polycystic ovary syndrome independently of obesity or sleep apnea.  Metabolism. 2006;  55 1076-1082
  • 58 Farrell S W, Cheng Y J, Blair S N. Prevalence of the metabolic syndrome across cardiorespiratory fitness levels in women.  Obes Res. 2004;  12 824-830

Anuja DokrasM.D. 

Associate Professor, Penn Fertility Care, University of Pennsylvania Medical Center

3701 Market St., Suite 800, Philadelphia, PA 19104

Email: ADokras@obgyn.upenn.edu