Cardiovascular disease in the polycystic ovary syndrome: New insights and perspectives

Abstract 

The new millennium has brought intense focus of interest on the risk of cardiovascular disease in women. The polycystic ovary syndrome (PCOS) is a common endocrine disorder in women characterised by hyperandrogenism and oligomenorrhoea. Most women with PCOS also exhibit features of the metabolic syndrome, including insulin resistance, obesity and dyslipidaemia. While the association with type 2 diabetes is well established, whether the incidence of cardiovascular disease is increased in women with PCOS remains unclear. Echocardiography, imaging of coronary and carotid arteries, and assessments of both endothelial function and arterial stiffness have recently been employed to address this question. These studies have collectively demonstrated both structural and functional abnormalities of the cardiovascular system in PCOS. These alterations, however, appear to be related to the presence of individual cardiovascular risk factors, particularly insulin resistance, rather than to the presence of PCOS and hyperandrogenaemia per se. However, given the inferential nature of the evidence to date, more rigorous cohort studies of long-term cardiovascular outcomes and clinical trials of risk factor modification are required in women with PCOS.

Abbreviations: BMI, body mass index, CIMT, carotid intima-medial thickness, DHEAS, dehydroepiandrosterone sulphate, ecNOS, endothelial nitric oxide synthase, FMD, flow mediated dilatation, HDL, high density lipoprotein, IVRT, isovolumetric relaxation time, LBF, leg blood flow, LDL, low density lipoprotein, LV, left ventricular, NIH, National Institutes for Health, NO, nitric oxide, PCO, polycystic ovaries, PCOS, polycystic ovary syndrome, PWV, pulse wave velocity

Keywords: Polycystic ovary syndrome, Cardiovascular function and structure, Cardiovascular risk, Insulin resistance