Prospective Association of Polycystic Ovary Syndrome With Coronary Artery Calcification and Carotid-Intima-Media Thickness

Abstract

Objective— To study the independent associations of polycystic ovary syndrome (PCOS), and its 2 components, hyperandrogenism and anovulation, with coronary artery calcification (CAC) and carotid artery intima-media thickness (IMT). Approach and Results— At the year 20 of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based multicenter cohort of young adults, women (mean age, 45 years) with information on menses and hirsutism in their twenties were assessed for CAC (n=982) and IMT (n=988). We defined PCOS as women who had both irregular menses and hyperandrogenism (n=55); isolated oligomenorrhea (n=103) as women who only had irregular menses; and isolated hyperandrogenism (n=156) as women who had either hirsutism or increased testosterone levels. Logistic regressions and general linear models were used to estimate the associations between components of PCOS and subclinical CVD. The prevalence of CAC was 10.3% overall. Women with PCOS had a multivariable adjusted odds ratio of 2.70 (95% confidence interval, 1.31–5.60) for CAC. Women with either isolated oligomenorrhea or isolated hyperandrogenism had no increased risk of CAC when compared with unexposed women. Women with PCOS had significantly increased bulb and internal carotid-IMT measurements; however, no significant differences were noted in bulb or internal carotid artery IMT among women with either isolated oligomenorrhea or isolated hyperandrogenism when compared with unexposed women. There were no differences in common carotid-IMT among the 4 study groups. Conclusions— In this study, women with PCOS, manifested as both anovulation and hyperandrogenism, but not women with one of these manifestations alone, were at increased risk for the development of subclinical CVD.

Oxidative stress and cardiovascular complications in polycystic ovarian syndrome

“…The two major anatomical markers for subclinical CVD in PCOS are coronary artery calcification (CAC) and carotid intima-media thickness (CIMT). Moreover, the prevalence of coronary artery and aortic calcifications is higher in PCOS women [77,78]. Previous reports demonstrate that in non-diabetic women with PCOS, the occurrence of CAC is 3-fold higher than in the control [79].…”

Referral bias in female functional hyperandrogenism and polycystic ovary syndrome

“…On the other hand, the classic hyperandrogenic and anovulatory PCOS phenotype that was particularly prevalent in referral patients is associated with insulin resistance and metabolic dysfunction more frequently than with ovulatory phenotypes, even after adjusting by fat mass (19). Furthermore, patients with classic PCOS may show an increased risk for the development of subclinical atherosclerosis compared with patients suffering ovulatory and nonhyperandrogenic PCOS phenotypes (20).…”

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

“…149 Differences in carotid intima-media thickness and impairment in peripheral vascular function could be attributed at least in part to insulin resistance, obesity, or dyslipidemia. 144,[150][151][152][153][154][155] Although a few studies report greater CAC in women with PCOS than in those who do not have PCOS, [156][157][158][159] these data must be interpreted cautiously because of the influence of obesity on CAC measurements and the low prevalence of detectable CAC among young women (5.1% of women 33-45 years of age). 160 In obesity, x-ray scatter from adjacent soft tissue increases the false-positive rate, with duplicate scans in obese individuals demonstrating the highest rate of false positives with CAC scores <10.…”