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PCOS Increases Risk For CVD

Jan 26, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Kamilla Avshalum, PharmD Candidate, LECOM School of Pharmacy

Insulin resistance and weight gain are common with PCOS and impact multiple CVD risk factors. 

Polycystic Ovary Syndrome, or PCOS, is one of the most prevalent endocrine disorders that affect women worldwide. Depending on the diagnosis guidelines, somewhere between 4 and 21 percent of the female population suffers from PCOS. The exact causes of PCOS are not known, but it is stipulated that at least in part, this disease is genetic. Polycystic Ovary Syndrome symptoms include acne, infertility, hirsutism, amenorrhea, mood disorders, and hyperinsulinemia. Even though doctors can treat one or several of the symptoms associated with PCOS, it’s tough to manage them all. Furthermore, typical treatment of Polycystic Ovary Syndrome focuses on immediate problems, like infertility, while ignoring long-term issues that could develop, such as weight gain, cardiovascular disease or CVD, coronary heart disease, and diabetes. Some studies on the topic have shown that these issues could develop regardless of BMI index.  

 

Research has shown that Polycystic Ovary Syndrome can lead to many CVD risk factors: dyslipidemia, hypertension, diabetes, insulin resistance, glucose intolerance, obesity, and metabolic syndrome. Most of these risk factors result from insulin resistance and weight gain, which is common with Polycystic Ovary Syndrome.   

A Brazilian cross-sectional study found that hypertension is prevalent in women with Polycystic Ovary Syndrome. The pervasiveness of hypertension in women who participated in this study (233 in the PCOS group and 70 in the control group) was 65% in women with Polycystic Ovary Syndrome versus 41% in women without. This study’s finding is unsurprising since obesity and overweight is a common problem in women with Polycystic Ovary Syndrome as well. An analysis of 1500 women that participated in 35 studies showed that women suffering from Polycystic Ovary Syndrome tend to be overweight. It’s theorized that once again, insulin resistance is responsible for causing weight problems in women with Polycystic Ovary Syndrome. However, it’s important to note that non-overweight women also suffer from PCOS and are at an increased risk for CVD.     

Multiple studies have focused on examining the prevalence of subclinical CVD markers in women who suffer from PCOS but do not exhibit traditional CVD risk factors.  One such study consisted of 30 to 45-year-old women with Polycystic Ovary Syndrome and focused on age and BMI, comparing it to a control group. This study found that women with PCOS were more likely to have coronary artery calcium (39%) than women without PCOS (21%).  The jury is still out on whether Polycystic Ovary Syndrome on its own can increase the risk of clinical CVD events or not. An eight-study analysis done in 2017 focused on 128k women between the ages of 36 to 71 years old. The average follow-up length in this study was 10 – 40 years and suggested that Polycystic Ovary Syndrome increases the likelihood of strokes. Still, this study was undermined due to the result not being statistically significant.    

In conclusion, Polycystic Ovary Syndrome should be taken seriously as it increases the risk of developing CVD in women. Patients should manage Polycystic Ovary Syndrome symptoms with methods that are specific to their circumstances. CVD risk factors such as gestational diabetes, family history of diabetes, hypertension, obesity, and history of IGT should be monitored and treatment adjusted based on their status. Monitoring should start with an initial doctor visit during which the patient’s fasting blood glucose and glycosylated hemoglobin level is established and then monitored in subsequent visits. Changes to daily routines such as diet and exercise should be put in place. Various studies have shown that weight loss of about 5 – 10% due to diet and exercise has positively affected reducing metabolic and CVD risks. If lifestyle adjustment alone doesn’t do the trick, patients with Polycystic Ovary Syndrome can take Metformin to stop the progression of diabetes. Another option is bariatric surgery.    

Practice Pearls:   

  • Obesity in women with PCOS can be associated with insulin resistance.  
  • The study suggests screening women with PCOS for type 2 diabetes every 1-3 years.  
  • Cardiovascular disease in women with PCOS is also seen in patients without obesity.  

 

Polycystic Ovary Syndrome and Cardiometabolic Risk: Opportunities For Cardiovascular Disease Prevention  

 

Kamilla Avshalum, PharmD Candidate, LECOM School of Pharmacy