Effect of PCOS on Cardiac Risk Remains Controversial - polycystic ovary syndrome - Brief Article

TORONTO -- The question of whether polycystic ovary syndrome is linked to an increased long-term cardiovascular event rate has emerged as a major area of controversy, Dr. Rogerio A. Lobo said at the annual meeting of the Endocrine Society.

In his evidence-based review, he found convincing evidence that polycystic ovary syndrome (PCOS) sharply increases a woman's risk of type 2 diabetes. The disorder is also characteristically associated with hypertriglyceridemia, low HDL cholesterol, obesity, and a threefold elevated risk of endometrial cancer. There is no indication of increased breast cancer risk.

Limited and conflicting data point to a possible PCOS-related increase in ovarian cancer. Hypertension, although common in the PCOS population, appears to be a byproduct of the obesity that's often part of the syndrome, said Dr. Lobo, professor of ob.gyn. at Columbia University New York.

PCOS-related anovulation is improved by controling the metabolic abnormalities, such as with insulin-sensitizing agents. Yet 30%-40% of PCOS patients who become pregnant miscarry; rates of pregnancy-induced hypertension, gestational diabetes, stillbirths, and preterm labor are elevated.

The common metabolic derangements in full-blown PCOS--reduced HDL cholesterol, high triglycerides, and reduced insulin sensitivity--often occur in milder form in the many women who have polycystic ovaries without amenorrhea or obesity

"One needs to identify these women--whether they have polycystic ovaries or the full-blown syndrome--identify what risk factors they have at the time, and follow them closely essentially forever," he said.

As to whether PCOS causes increased cardiovascular risk, "I think we really don't know Current data would suggest no, except in the diabetics," Dr. Lobo said.

He cited 32-year follow-up data on more than 700 English women diagnosed with PCOS at a mean age of 25 years. Coronary heart disease morbidity and mortality were no higher than in age-matched controls, despite the PCOS group's high level of cardiovascular risk factors.

But Dr. Andrea Dunaif pointed to new data from the far larger Nurses' Health Study There was a 50% increase in the risk of coronary events in women who reported having menses less frequently than every 40 days, said Dr. Dunaif of Brigham and Women's Hospital, Boston.

Dr. Rose C. Christian of the Mayo Clinic, Rochester, Minn., also criticized the British study In an interview, she cited the study's retrospective nature and the fact that participants were diagnosed more than 30 years ago in an era before the diagnosis could be reliably made.

In her electron beam CT coronary artery calcification study of 32 PCOS patients and 52 ovulatory controls matched by age and body mass index, evidence of atherosclerosis was seen in 36% of the PCOS group, a prevalence 2.5-fold greater than in controls. And the prevalence was 5,5-fold greater among PCOS patients than in a community database comprising 600 individuals of similar age.

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