Effect of polycystic ovary syndrome on cardiac autonomic function at a late fertile age: a prospective Northern Finland Birth Cohort 1966 study

Abstract

ObjectivesPrevious studies of women in their 20s and 30s have reported impaired autonomic function in women with polycystic ovary syndrome (PCOS). We aimed to study, for the first time, whether PCOS is associated with impaired cardiac autonomic function independent of metabolic and hormonal status in their late reproductive years.DesignA prospective Northern Finland Birth Cohort 1966 (NFBC1966) study including 5889 women born in 1966 and followed through the age of 46. At that age, n=3706/5123 women (72%) answered the postal questionnaires and n=3280/5123 women (64%) participated in the clinical examination.SettingGeneral community.ParticipantsThe sample included women presenting both irregular menses (oligomenorrhoea or amenorrhoea) and hirsutism at age 31 (n=125) or with formally diagnosed PCOS by age 46 (n=181) and women without PCOS symptoms or diagnosis (n=1577).Primary and secondary outcome measuresHeart rate variability parameters: the root mean square of successive R-R differences (rMSSD), spectral power densities (LF: low frequency and HF: high frequency) and baroreflex sensitivity (BRS).ResultsWe found that parasympathetic activity (assessed by rMSSD: 19.5 (12.4; 31.9) vs 24.3 (16.1; 34.8) ms, p=0.004 and HF: 172 (75; 399) vs 261 (112; 565) ms2, p=0.002) and BRS (6.13±3.12 vs 6.99±3.52 ms/mm Hg, p=0.036) were lower in women with PCOS compared with the controls. However, in the multivariate regression analysis, PCOS, body mass index and the free androgen index did not significantly associate with rMSSD, whereas blood pressure, insulin resistance and triglycerides did.ConclusionsWe report here for the first time that late reproductive-aged women with PCOS display impaired cardiac autonomic function manifested as decreased vagal activity. Metabolic status, rather than hyperandrogenaemia and PCOS per se, was the strongest contributing factor. Given the link between cardiac morbidity and impaired autonomic function, the findings underline the importance of screening and treating metabolic abnormalities early on in women with PCOS.

Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age: A population‐based cohort study

“…The use of beta blockers was higher in women with PCOS than in the controls. Given that the first‐line treatment for high blood pressure are medications targeting the renin–angiotensin system, it may be that the beta‐blocking agents were prescribed for indications other than hypertension, 41 such as anxiety symptoms, which are highly prevalent in PCOS, 10 as is sympathetic excitation 42 . The higher use of medications affecting the “nervous system” in PCOS was expected, given the psychological morbidity related to the syndrome 11 .…”

Polycystic ovary syndrome and leukocyte telomere length: cross-sectional and longitudinal changes

“…Longer exposure to endogenous estrogen or use of postmenopausal hormone therapy have been associated with greater telomere length and a lower risk of age-related diseases (51,53). In keeping with this hypothesis, women with PCOS, despite numerous metabolic risk factors, do not seem to experience as many cardiometabolic events as might be expected (50,54,55), although opposite results have also been reported (45,46,56). These findings raise interesting questions about the relationship between estrogen levels and telomere lengths.…”

“…The samples were analyzed at NordLab Oulu, a testing laboratory (T113) accredited by the Finnish Accreditation Service (FINAS) (EN ISO 15189). BMI values at both ages (from clinical examination and postal questionnaire) were combined to create a variable where clinically measured BMI was used if available and self-reported BMI was used in other cases (45).…”

“…Detailed information about laboratory methods for hormonal and metabolic parameters has been published previously ( 44 ). At age 31, the concentration of sex hormone-binding globulin (SHBG) was analyzed by fluoroimmunoassay (Wallac, Inc. Ltd., Turku, Finland).…”

Excess of ovarian nerve growth factor impairs embryonic development and causes reproductive and metabolic dysfunction in adult female mice

“…[7][8][9] PCOS is a common endocrinopathy among women of reproductive age, which is characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries and manifests as heterogeneous reproductive and metabolic complications. 10 Women with PCOS have increased general sympathetic nerve and decreased vagal activity, [11][12][13][14] and it is proposed that an altered ovarian sympathetic activity may contribute to the development of the syndrome. 9 This notion is supported by increased density of catecholaminergic nerve fibers in the ovaries of women with PCOS, 15 and by increased levels of NGF in their follicular fluid.…”