High Androgens in Postmenopausal Women and the Risk for Atherosclerosis and Cardiovascular Disease: The Rotterdam Study

Meun, Cindy; Franco, Oscar H.; Dhana, Klodian; Jaspers, Loes; Muka, Taulant; Louwers, Yvonne V.; Ikram, M. Arfan; Fauser, Bart C.J.M.; Kavousi, Maryam; Laven, Joop S.E.

doi:10.1210/jc.2017-02421

Cited by 85 publications

(73 citation statements)

References 28 publications

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“…On the contrary, a 21-year follow-up study of 35 postmenopausal PCOS women with history of wedge resection, showed similar prevalence of myocardial infarction and stroke between PCOS and control group 7, and a retrospective observational study did not found any increased risk for large vessel disease in women with PCOS (mean age 30yr) (32). Additionally, a recent study reported that women with high postmenopausal androgen levels and retrospectively diagnosed with PCOS did not display an elevated risk for CVD (33). It has been postulated that later age at menopause and consequently, more prolonged oestrogen exposure, could alleviate the CVD burden in PCOS despite the high CVD risk profiles commonly present in these women.…”

Section: Discussionmentioning

confidence: 93%

Self-Reported Polycystic Ovary Syndrome Is Associated With Hypertension: A Northern Finland Birth Cohort 1966 Study

Ollila

Kaikkonen

Järvelin

et al. 2018

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Polycystic ovary syndrome (PCOS) is associated with many traditional cardiovascular disease risk factors, but it is unclear whether PCOS is an independent risk factor for hypertension. Objective To investigate in a population-based setup whether PCOS associates with the risk of hypertension independently of body mass index (BMI) and with cardiovascular manifestations. Design Cross-sectional assessments in the Northern Finland Birth Cohort 1966 at ages 31 and 46 years. Setting General community. Participants Women who reported both oligo/amenorrhea and hirsutism at age 31 years and/or a diagnosis of PCOS by age 46 years [self-reported PCOS (srPCOS), n = 279] and women without PCOS symptoms or diagnosis (n = 1577). Intervention None. Main Outcome Measures Blood pressure (BP), BMI, and cardiovascular manifestations. Results Use of antihypertensive medication was significantly more common in women with srPCOS. At age 31 years, women with srPCOS had significantly higher systolic BP (SBP) and diastolic BP (DBP) than control women (SBP: normal weight: 119.9 ± 13.2 vs 116.9 ± 11.4 mm Hg, P = 0.017; overweight/obese: 126.1 ± 14.3 vs 123.0 ± 11.9 mm Hg, P = 0.031; and DBP: normal weight: 75.5 ± 10.0 vs 72.4 ± 9.6 mm Hg, P = 0.003; overweight/obese: 80.7 ± 11.8 vs 78.0 ± 10.6 mm Hg, P = 0.031). At age 46 years, srPCOS was significantly associated with hypertension (adjusted odds ratio = 1.56; 95% CI, 1.14 to 2.13) independently of BMI and with higher cardiovascular morbidity (6.8% vs 3.4%, P = 0.011). Hypertensive srPCOS displayed consistent, unfavorable changes in cardiac structure and function compared with controls. Conclusion Women with srPCOS displayed higher BP compared with controls already at early age and srPCOS was associated with hypertension independently of overweight/obesity. srPCOS was associated with increased cardiovascular morbidity in premenopausal women, suggesting that cardiovascular disease risk factors should be screened and efficiently managed early enough in women with PCOS.

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Section: Discussionmentioning

confidence: 93%

Self-Reported Polycystic Ovary Syndrome Is Associated With Hypertension: A Northern Finland Birth Cohort 1966 Study

Ollila

Kaikkonen

Järvelin

et al. 2018

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…31,32 Furthermore, coronary artery calcification is associated with PCOS with odds ratios ranging from 2.3 to 2.4. 33,34 The Coronary Artery Risk Development in Young Adults (CARDIA) study found that women with both hyperandrogenemia and oligomenorrhea (phenotype A) had an increased prevalence of coronary artery calcifications and increased carotid intima-media thickness, but women with 5,37 If screening identifies CVD risk factors such as obesity, cigarette smoking, dyslipidemia, hypertension, IGT, and lack of physical activity, women should be considered to be at risk of CVD and screening planned as appropriate. 5…”

Section: Metabolic Syndromementioning

confidence: 99%

A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines

et al. 2018

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Polycystic ovary syndrome (PCOS) is a common hormonal condition with reproductive, metabolic, and psychological sequelae. The Rotterdam Criteria are now internationally accepted, with different phenotypes recognized with varying clinical presentations and risk profiles. The complexity of the disorder, and the impact on quality of life, requires timely diagnosis, screening for complications and management strategies. PCOS remains underdiagnosed and women experience significant delays to diagnosis. Effective dissemination of evidence-based management is therefore vital. In this review, we summarize key aspects of PCOS as a prelude to this issue of on PCOS which focuses on the development of the international evidence-based guideline on the assessment and management of PCOS and the related translation program. We cover diagnostic criteria, prevalence, phenotypes, reproductive, metabolic, and psychological factors of PCOS. We also cover management strategies including lifestyle interventions as well as treatment of nonreproductive outcomes and reproductive outcomes informed by the latest international evidence-based guidelines.

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“…Testosterone has, previously, been associated with unfavorable metabolic factors in premenopausal women (56,57). However, whether high androgens have a protective or unfavorable influence on the manifestation of CVD in women with PCOS has not been settled (58,59). Interestingly, metabolic health may be better than expected in postmenopausal women with previous PCOS, as no strong positive associations were found between testosterone levels and risk of CVD (59).…”

Section: Ogtt As a Marker Of Long-term Metabolic Risk And Cvdmentioning

confidence: 99%

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Andersen

Glintborg

2018

European Journal of Endocrinology

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Polycystic ovary syndrome (PCOS) is common in premenopausal women. The majority of women with PCOS have insulin resistance and the risk of type 2 diabetes mellitus (T2D) is higher in women with PCOS compared to controls. In non-pregnant women with PCOS, glycemic status may be assessed by oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) or HbA1c. OGTT has been reckoned gold standard test for diagnosing T2D, but OGTT is rarely used for diagnostic purpose in other non-pregnant individuals at risk of T2D, apart from PCOS. OGTT has questionable reproducibility, and high sensitivity of the 2-h glucose value is at the expense of relatively low specificity, especially regarding impaired glucose tolerance (IGT). Furthermore, lean women with PCOS are rarely diagnosed with T2D and only few percent of normal-weight women have prediabetes. Glycemic status is necessary at diagnosis and during follow-up of PCOS, especially in women with high risk of T2D (obesity, previous gestational diabetes (GDM)). We suggest that OGTT should be used in the same situations in PCOS as in other patient groups at risk of T2D. OGTT is indicated for diagnosing GDM; however, OGTT during pregnancy may not be indicated in lean women with PCOS without other risk factors for GDM.

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High Androgens in Postmenopausal Women and the Risk for Atherosclerosis and Cardiovascular Disease: The Rotterdam Study

Abstract: Postmenopausal high androgen levels were not associated with an elevated risk for CVD. Cardiovascular health in women with PCOS might be better than was anticipated.

Cited by 85 publications

References 28 publications

Self-Reported Polycystic Ovary Syndrome Is Associated With Hypertension: A Northern Finland Birth Cohort 1966 Study

Self-Reported Polycystic Ovary Syndrome Is Associated With Hypertension: A Northern Finland Birth Cohort 1966 Study

A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

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