Cardiovascular events among reproductive and menopausal age women with polycystic ovary syndrome: a systematic review and meta-analysis

Tehrani, Fahimeh Ramezani; Amiri, Mina; Behboudi‐Gandevani, Samira; Yarandi, Razieh Bidhendi; Carmina, Enrico

doi:10.1080/09513590.2019.1650337

Cited by 68 publications

(28 citation statements)

References 52 publications

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“… 66 This increased risk was maintained when examining ischaemic heart disease 66 and stroke 85 separately (supplementary table 3). Results from population based studies suggested that, compared with healthy controls, the risk of cardiovascular events was increased in young women in the reproductive age group with polycystic ovary syndrome (hazard ratio 1.43, 95% confidence interval 1.27 to 1.61); no association was seen in postmenopausal women with polycystic ovary syndrome (supplementary table 3) 70 but this review was rated as low quality. Based on the results of one cross sectional study, 86 no association was found between polycystic ovary syndrome and the risk of heart failure ( table 1 and supplementary table 4).…”

Section: Resultsmentioning

confidence: 95%

“…Twenty three reviews reported overlapping associations. 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 Overlapping associations included: current use of combined oral contraceptives and risk of myocardial infarction, n=2 55 56 ; use of combined oral contraceptives and risk of ischaemic stroke, n=3 55 56 67 ; use of combined oral contraceptives and risk of haemorrhagic stroke, n=2 56 71 ; use of progesterone only pill and risk of stroke, n=2 72 73 ; use of combined oral contraceptives in migraine and risk of stroke, n=2 74 75 ; early menarche and mortality from cardiovascular disease, n=2 76 77 ; early menopause and risk of fatal cardiovascular disease, n=3 57 58 59 ; pre-eclampsia and risk of cardiovascular disease, n=2 60 61 ; gestational diabetes and risk of cardiovascular disease, n=3 62 63 69 ; preterm birth and risk of cardiovascular disease, n=3 60 64 65 ; and polycystic ovary syndrome and risk of cardiovascular disease, n=3. 66 68 70 Appendix 8 describes the general characteristics of the reviews with overlapping associations, including the decision to retain or exclude an association from the analysis.…”

Section: Resultsmentioning

confidence: 99%

“… 68 The overview summarised evidence from two systematic reviews. 66 127 Our review synthesised evidence from another three reviews, including one evaluating the risk of heart failure, 70 85 87 but no evidence of an increased risk of heart failure in women with polycystic ovary syndrome was found. Results on the risk of heart failure were based on one cross sectional study that reported imprecise results.…”

Section: Discussionmentioning

confidence: 99%

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Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Okoth

Chandan

Marshall

et al. 2020

BMJ

233

171

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Objective To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. Design Umbrella review. Data sources Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. Review methods Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. Results 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. Conclusions From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. Systematic review registration PROSPERO CRD42019120076.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Okoth

Chandan

Marshall

et al. 2020

BMJ

233

171

View full text Add to dashboard Cite

show abstract

“…Therefore, once the diagnosis of PCOS is made, there should be an assessment of metabolic status and comorbidities (37). Recently, a systemic study summarized the findings of 16 studies and found a greater risk of CVD in the women of reproductive age with PCOS (5). According to the recently published international PCOS guidelines, the global CVD risk should be routinely assessed in women with PCOS (38).…”

Section: Discussionmentioning

confidence: 99%

“…Insulin resistance (IR) and androgen excess are prevalent in patients with PCOS (2,3). Previous studies have demonstrated that almost all cardiovascular risk factors including IR, diabetes mellitus (DM), dyslipidemia, obesity, hypertension, and metabolic syndrome are associated with PCOS (4)(5)(6)(7)(8). These risk factors are present even in young patients with PCOS and predispose to the development of endothelial dysfunction, early atherosclerosis and cardiovascular disease (CVD) (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Hypertension Risk in Young Women With Polycystic Ovary Syndrome: A Nationwide Population-Based Cohort Study

Chiu

Chang

et al. 2020

Front. Med.

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Efficacy of myo‐inositol and d‐chiro‐inositol combination on menstrual cycle regulation and improving insulin resistance in young women with polycystic ovary syndrome: A randomized open‐label study

Kachhawa

Kumar

Kulshrestha

et al. 2021

Intl J Gynecology & Obste

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Objective: To compare the effect of myo-inositol and d-chiro-inositol in combination (MI + DCI) with combined hormonal contraceptive (CHC) on menstrual cycle regulation in young Indian women with polycystic ovary syndrome (PCOS).Methods: Seventy young women with PCOS aged 15-24 years with delayed cycles were randomized into two groups and were treated for 6 months with MI + DCI (550 + 150 mg, 3.6:1 ratio) twice a day and CHC (ethinyl estradiol 20 µg + drospirenone 3 mg) once a day. Results: Spontaneous menses resumed in 28 (84.85%) young women on MI + DCI, compared with withdrawal bleeding in 34 (100%) on CHC. The mean cycle length reduced with both MI + DCI (124.54 ± 8.08 to 57.75 ± 3.00 days, P < 0.001) and CHC (105.88 ± 7.96 to 30.53 ± 2.95 days, P < 0.001). Regular menstrual cycles were established in 9 (27.27%) young women with MI + DCI (P = 0.001) and 30 (88.23%) with CHC (P < 0.001). Three months after stopping the treatment, 24 young women (85.71%) on MI + DCI and 25 (73.53%) on CHC continued to have spontaneous cycles. Anti-Müllerian hormone decreased with both the drugs (P = 0.001), whereas luteinizing hormone (P = 0.001) and testosterone (P = 0.04) decreased with CHC and homeostatic model assessment of insulin resistance (P < 0.001) with MI + DCI. Conclusion: Myo-inositol and d-chiro-inositol in combination (3.6:1 ratio) are effective in regularizing menstrual cycles and improving insulin resistance. Trial registration: Clinical Trials Registry of India (CTRI/2018/03/012643). http://ctri.nic.in/Clini caltr ials/pmain det2.php?trial id=20969 &EncHi d=&userN ame=myo-inositol K E Y W O R D S menstrual cycle regulation, myo-inositol and d-chiro-inositol combination, polycystic ovary syndrome, young women How to cite this article: Kachhawa G, Senthil Kumar KV, Kulshrestha V, Khadgawat R, Mahey R, Bhatla N. Efficacy of myo-inositol and d-chiro-inositol combination on menstrual cycle regulation and improving insulin resistance in young women with polycystic ovary syndrome: A randomized open-label study.

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Cardiovascular events among reproductive and menopausal age women with polycystic ovary syndrome: a systematic review and meta-analysis

Cited by 68 publications

References 52 publications

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Hypertension Risk in Young Women With Polycystic Ovary Syndrome: A Nationwide Population-Based Cohort Study

Efficacy of myo‐inositol and d‐chiro‐inositol combination on menstrual cycle regulation and improving insulin resistance in young women with polycystic ovary syndrome: A randomized open‐label study

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