Polycystic Ovary Syndrome: A Common Endocrine Disorder and Risk Factor for Vascular Disease

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of reproductive age, impacting 5-10% of premenopausal American women. During the reproductive years, women with PCOS seek medical attention related to infertility, hirsutism, and acne. About 60% of women with PCOS are obese and insulin resistant. Up to 40% of women with PCOS will develop diabetes by the age of 50 and many are dyslipidemic. In addition to treating the cosmetic and fertility issues associated with PCOS, health care providers must educate patients regarding the long-term cardiovascular consequences associated the this disorder. At menopause, a woman with PCOS is likely to have had multiple cardiac risk factors for several decades. Postmenopausal women with a history of PCOS, especially those with established diabetes and/or dyslipidemia, should be considered at high risk for the development of clinical cardiac disease. Exercise and a prudent calorie-restricted diet aimed at weight loss must be stressed early. Pharmacologic therapy for diabetes and hyperlipidemia should be used when appropriate. Bariatric surgery, known to positively impact all the aforementioned cardiac risk factors, may also be of benefit.

Epicardial fat and vascular risk

“…Women with polycystic ovary syndrome (PCOS) also had increased epicardial adipose tissue compared with healthy individuals [48,49]. PCOS is associated with high CVD risk [50]. In patients with nonalcoholic fatty liver disease (NAFLD), the hepatic manifestation of MetS that is significantly linked to vascular risk [51], epicardial fat was higher and coronary flow reserve lower than in controls, while in stepwise regression analysis epicardial fat independently predicted coronary flow reserve [52].…”

Possible Role of Nrf2 in Oxidative and Inflammatory Processes During Menopause

“…There are studies that support it as an additional cardiovascular risk even during premenopausal phase, because these patients develop early arterial disease, and have a higher prevalence of hypertension, dyslipidemia, incidence of myocardial infarction, thickness of the intima-media, arterial stiffness, and endothelial dysfunction [19]. This is aggravated if a woman has diabetes and dyslipidemia [20]. On the other hand, another study indicates that these patients had fewer climacteric symptoms than controls [21], further have insulin resistance attenuated.…”

Polycystic Ovary Syndrome: A Common But Often Unrecognized Condition

“…Insulin resistance is reported to affect 50% to 80% of women with PCOS and is more severe in women who are overweight or obese 31 . Moreover, at least 10% of women with PCOS will develop diabetes mellitus, 32 with some researchers estimating that as many as 40% will develop diabetes by 50 years of age 33 . In women with PCOS with a normal glucose metabolism initially, there can be a 25% conversion to abnormal glucose metabolism within 3 years 34 .…”