Women with Polycystic Ovary Syndrome at Increased Risk of Cardiovascular Disease Events

A comparison of women with PCOS to matched controls indicates women with PCOS were at a 26% greater risk of experiencing major adverse cardiovascular events than their counterparts without polycystic ovary syndrome.

An analysis of nearly 175k patients with polycystic ovary syndrome (PCOS) is detailing the increased risk of cardiovascular disease associated with the common hormonal endocrine disorder.

Results of the analysis suggest young women with PCOS were at an increased risk of adverse cardiovascular events and also indicate weight and diabetes status stood out as potentially modifiable risk factors for this association.

“This is the largest study to confirm an increased incidence of major cardiovascular morbidity in patients with PCOS and emphasizes the importance of recognizing the disorder as a higher-risk vascular condition,” wrote investigators.

With PCOS the most common endocrine condition impacting young women and the relationship between PCOS and cardiovascular risk unclear, a UK-based team of investigators sought to explore these potential associations using data from the Clinical Practice Research Datalink Aurum database. With more than 200,000 women with PCOS included in the database from 1998-2017, investigators identified a cohort of 181,916 meeting eligibility criteria for inclusion in their matched analyses.

All patients included in the study were at least 18 years of age or older and were matched in a 1:1 ratio to a set of non-PCOS controls based on age, BMI category, and primary care practice. Investigators pointed out patients with a history of myocardial infarction, stroke, angina, or revascularization were excluded from survival analyses.

The primary outcome of interest for the study was time to major adverse cardiovascular event (MACE), which was defined as myocardial infarction, stroke, angina, revascularization, and cardiovascular mortality. The secondary outcomes of interest were individual components of the composite MACE endpoint.

Of the 181,916 deemed eligible for inclusion, 174,660 were matched to non-PCOS controls. The median follow-up time for patients with PCOS was 3.83 (IQR, 1.89-7.78) years and 3.00 (IQR, 1.37-6.36) for controls. Investigators noted significant differences in presence of extreme obesity (4.65% vs 3.12%) were evident at baseline between the cohorts and women with PCOS were also more to have a higher Charlson Index score and higher blood pressure.

Analysis indicated crude rates of the composite endpoint, MI, stroke, angina, revascularization, and cardiovascular mortality were 82.7, 22.7, 27.4, 32.8, 10.5, and 6.97 per 100,000 patient-years, respectively, for women with PCOS and 64.3, 15.9, 25.7, 19.8, 7.13, and 7.75 per 100,000 patient-years, respectively, for matched controls. In adjusted models, women with PCOS were at 26% greater risk of the composite outcome (HR, 1.26; 95% CI, 1.13-1.41) and 38%, 60%, and 50% greater risk for myocardial infarction (HR, 1.38; 95 CI, 1.11-1.72), angina (HR, 1.50; 95% CI, 1.32-1.94), and revascularization (HR, 1.50; 95% CI, 1.08-2.07), respectively, when compared to non-PCOS controls.

In time-dependent models, results suggested weight gain (HR, 1.01; 95% CI, 1.00-1.01), prior type 2 diabetes (HR, 2.40; 95% CI, 1.76-3.30), and social deprivation (HR, 1.53; 95% CI, 1.11-2.11) were factors associated with increased risk of progression to the composite endpoint.

“Our study demonstrates that young women with a diagnosis of PCOS have an increased incidence of major cardiovascular events, whether captured as a composite outcome or as myocardial infarction, angina and revascularization individually,” wrote investigators. “High-quality longitudinal studies are now needed to understand any effect of disease phenotype and ethnicity on risk, and whether screening strategies with targeted intervention can lead to improved cardiovascular outcomes.”

This study, “Women with Polycystic Ovary Syndrome have an increased risk of major cardiovascular events: a population study,” was published in the Journal of Clinical Endocrinology and Metabolism.