In part 5 of this Exclusive Interview, Rhoda Cobin talks with Diabetes in Control Medical Editor Joy Pape about the long-term dangers of PCOS and the varying risks and increased mortality in women who have co-morbidities related to PCOS.
Rhoda H. Cobin, MD, MACE is Clinical Professor of Medicine at the Ichan School of Medicine at Mount Sinai in New York.
Transcript of this video segment:
Pape: And so, what are the long-term consequences of these problems?
Cobin: Serious ones. Serious ones. So, the first thing I should say is we’re focusing on diabetes. And we know from some of the pediatric endocrine clinics, for instance the children at Yale that have been studied, the younger they developed diabetes particularly if it’s not well controlled, the more likely they are to have microvascular complications of diabetes, so neuropathy, nephropathy, kidney failure, and eye disease, retinopathy. So, the longer somebody has diabetes, type 1 or type 2, the more likely they are to have small blood vessel disease. That really hasn’t been studied specifically in PCOS women. But you can imagine that if they start young and they’re not identified and they’re not treated, that by the time they’re picked up they may already have these microvascular complications. So, if you look at older literature where there wasn’t much in a way of diabetes screening, people with type 2 diabetes and that’s typically what PCOS ladies get, we had an incidence of retinopathy, eye disease, of somewhere around 50% when they were diagnosed with diabetes. They already had eye disease. Now, over time that has changed as the diabetes community has encouraged screening for diabetes even in the general population. So, if we know in these PCOS ladies that they’re looking at diabetes even at younger and younger ages, one could anticipate if we don’t pick it up that they may have more microvascular disease. There are not any good studies on that. But when you turn to macrovascular disease, that is to say diseases of the large blood vessels, coronary disease that causes heart attacks and carotid disease that causes strokes, we know that women with PCOS also have in addition to metabolic syndrome and hypertension, they have disorders of lipid metabolism. So, the classic metabolic syndrome lipid pattern is a decreased HDL, good cholesterol, and elevated triglycerides. But PCOS women have also been shown to have slightly higher LDL levels as well. And smaller LDL particles and larger numbers of small LDL particles which are more likely to produce a disease in the arteries. So, if we know that they have hypertension, they have impaired fasting glucose, they have insulin resistance, and they have lipid disorders, what are the risks? The risks are heart attack, stroke. And it’s been shown that over time now there are about five or six pretty good studies looking at women with PCOS. They tend to get heart disease earlier. It tends to be more progressive, and it tends to produce when they do have a heart attack, more death. So, in various studies the risk of having a heart attack is somewhere around three times as great as in the general population. And the risk of death from a heart attack in women with PCOS is probably twice that of the general population. And again, more and more studies are accruing overtime to look at this and this is sort of a work in progress. We’ll know more as time goes on.