PCOS identified as cardiovascular and diabetes risk factor

A diagnosis of polycystic ovary syndrome (PCOS) can signal that a woman is more likely to develop cardiovascular disease and diabetes, according to two separate studies presented this week at the Society for Endocrinology annual meeting in Harrogate. The findings should alert women with PCOS and their doctors to these serious health risks, which can often be reduced via timely lifestyle interventions.

PCOS occurs when the ovaries produce excessive amounts of male hormone (testosterone), although what causes this is as yet poorly understood. A link between PCOS and other long-term conditions has long been suspected due to this imbalance of sex hormones. PCOS is estimated to affect 5-10% of women of reproductive age and may cause menstrual problems often with associated infertility, abnormal hair growth (hirsutism) and other symptoms such as greasy skin and weight gain.

In the first study, researchers at University Hospitals of Leicester NHS Trust and the University of Leicester, led by Consultant Endocrinologist Dr Trevor Howlett, analysed data on cardiovascular events in women presenting with PCOS to Leicestershire’s main endocrine clinics over 20 years (n=2,353), and compared this with data on the local background female population (controls, n=432,506). They found that cardiovascular disease occurred significantly more frequently in women with PCOS aged 45 or older: the prevalence of heart attack and angina in women aged 45-54 was 1.9% and 2.5% in women with PCOS vs. 0.2% and 0.8% in age-matched controls (p<0.0001) and remained significantly higher for heart attack in older women (those aged 55+, p<0.0001).

Dr Trevor Howlett, Lead Investigator and Consultant Endocrinologist at University Hospitals of Leicester NHS Trust, said:

“Our study clearly shows that a simple diagnosis of PCOS is associated with an increased risk of developing cardiovascular disease many years later, with cardiovascular events occurring almost 10 times more frequently in some age groups. The precise mechanism which results in this increased risk remains uncertain, but this information certainly highlights the need to consider cardiovascular risk in women with this common condition, and to prompt lifestyle changes, such as eating a healthy diet, maintaining a healthy weight, and stopping smoking, which have been proven to reduce the overall risk of cardiovascular disease. On the back of this research, we are currently developing lifestyle intervention and education programmes for women with PCOS on this very theme.”

                                                                                           

In another study to be presented at the Society for Endocrinology annual meeting, researchers led by Dr Aled Rees from Cardiff University, UK, selected 21,734 young women (average age 27 years) with a new or recent diagnosis of PCOS between 1990 and 2010 from the General Practice Research Database and matched them to 86, 936 controls. In one group the subjects were matched to women without PCOS who were treated in the same practice and were of a similar age. In a second subjects were additionally matched by weight (BMI). In the first group they found that women with PCOS were three times more likely to develop type 2 diabetes than controls (‘time to diabetes' hazard ratio = 3.015, p<0.001, adjusted for practice and age). In the second group (matched by practice, age and BMI) the additional risk of developing diabetes dropped to 1.785 (p<0.001). The risk of developing type 2 diabetes thus appears to be linked in part to BMI, making weight management a crucial aspect of care for these patients. The study also found no link between PCOS and large vessel disease, cancer or death in these young women.

Dr Aled Rees, Lead researcher and Senior Lecturer and Consultant Endocrinologist at Cardiff University said:

“Our study is the first to show that an increased risk of diabetes in women with PCOS can be modified by weight gain. Women given a diagnosis of PCOS can be reassured that their higher risk of diabetes can be at least partly reduced through maintaining a healthy weight, which can also help with the symptoms of PCOS itself. Our research indicates that close monitoring of PCOS patients who have difficulty managing their weight could help to catch the development of diabetes early.”

These studies confirm that women diagnosed with PCOS are more likely to encounter certain chronic conditions later in life. Whilst the studies don’t show the root cause, establishing PCOS as a risk factor for these conditions is useful in itself: evidence shows that lifestyle interventions can be effective in mitigating, stalling or even preventing cardiovascular disease and diabetes.