KatCarney

Family Pratice News
June 15, 2000

PCOS Is Not Linked to Increased Coronary Risk.(Brief Article)(Statistical Data Included)

Author/s: Bruce Jancin

VICTORIA, B. C. -- Women with polycystic ovary syndrome don't experience increased coronary mortality or morbidity with aging, despite very high levels of cardiovascular risk factors, Dr. Sarah H. Wild reported at an international conference on women, heart disease, and stroke.

This was the central finding of her 32-year follow-up of 786 English women diagnosed with polycystic ovary syndrome (PCOS) at a mean age of 25 years. The observed paradox--high levels of coronary risk factors yet no significant increase in events--raises the intriguing possibility that PCOS may be associated with some as-yet-unknown factor that protects against coronary heart disease and counterbalances the increased burden of risk factors associated with the endocrine disorder, said Dr. Wild of the London School of Hygiene and Tropical Medicine.

Data from the National Health Service central registry, showed that for 786 PCOS patients who were followed up for 32 years, there was no increase in all-cause mortality, compared with national averages, nor in coronary heart disease mortality or breast cancer mortality But the death rate because of diabetes was significantly higher than in the general population.

Morbidity data were obtained via patient questionnaires or medical records for 319 of the women diagnosed with PCOS 32 years earlier as well as from 1,060 age- and geographically matched controls. An equal percentage of the PCOS group and controls were current smokers. The prevalence of obesity as defined by a body mass index above 30 kg/[m.sup.2] was significantly greater among PCOS patients by a margin of 26% to 18%. The PCOS group also had a significantly greater waist-to-hip ratio at follow-up than did the controls.

The prevalence of diabetes was 6.9% in the PCOS cohort and 3% among controls. After statistical adjustment for body mass index in a logistic regression analysis, the PCOS group had a 2.2-fold increased prevalence of diabetes. The adjusted odds ratio for hypercholesterolemia in the PCOS group was 3.2. The PCOS population also had a borderline excess of hypertension, with an adjusted odds ratio of 1.4.

Yet despite the increased rates of obesity diabetes, high cholesterol, and central adiposity, the PCOS group did not have increased coronary heart disease morbidity.

But women with PCOS did have an adjusted 3.4-fold increased rate of nonfatal stroke or transient ischemic attacks.

This is the first large-scale, long-term follow-up of a group of women with PCOS. Researchers in an earlier Swedish study involving 33 PCOS patients concluded that PCOS was associated with a sevenfold increased relative risk of acute MI, a finding that wasn't borne out by Dr. Wild's much larger and longer study.

PCOS patient information Web sites quote the Swedish report as evidence that women with PCOS are at markedly increased risk of heart disease.

Given the new study, perhaps the best advice that can be provided to PCOS patients is to try to maintain a healthy body weight. Also, if the excess risk of stroke and transient ischemic attacks is confirmed by other studies, it will mean that control of hypertension is very important in women with PCOS, she said.




As for the possibility that PCOS is associated with a cardioprotective factor, Dr. Wild speculated that vascular endothelial growth factor (VEGF) may be a reasonable candidate. VEGF seems to protect against heart disease and is being tested in gene therapy studies as a treatment for ischemic limbs and coronary syndromes.

VEGF happens to be present at increased levels in women with PCOS. It is one of the reasons that they are prone to ovarian hyperstimulation syndrome when given infertility therapy, Dr. Wald said.


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