Endocrine Abstracts

Women with PCOS show increased cardiovascular risk factors compared to weight matched controls with normal ovarian function. The evidence is broadly consistent for deranged lipids (in particular elevated triglyceride and low HDL-cholesterol) and greater glucose intolerance in women with PCOS. Evidence of hypertension is less consistent. There are also preliminary data now for altered haemostatic (t-PA antigen) and inflammatory (C-reactive protein concentrations) factors. All such risk factor abnormalities are in line with the pattern linked to insulin resistance and a greater propensity of the metabolic syndrome, however defined. In line with such data, invasive (angiography) and non-invasive tests (calcification, IMT) have reported greater atherosclerotic burden in PCOS. More importantly, a recent prospective study has linked menstrual irregularity, approximately 80% of which is due to PCOS, to around a 50% elevated risk of CHD events (fatal and non-fatal) even after adjusting for BMI and other confounders. However, definitive evidence of excessive CHD events or mortality in women with confirmed PCOS from large prospective studies is currently lacking.

In clinical terms, all women with PCOS should have an assessment of at least fasting glucose to screen for diabetes. However, determination of lipid profiles is unlikely to alter management until they reach late 30’s or early 40’s, unless significant other risk factors are present since absolute CHD risk is generally low in younger women. The decision to consider cardioprotective agents (e.g. statins) should currently be based on existing risk factor charts. However, all women should receive advice or perhaps greater input regarding lifestyle factors (diet and physical activity) as such changes can have multiple benefits.

Finally, there is increasing evidence from the diabetes and pre-diabetes literature to indicate metformin may significantly lessen risk for diabetes and CHD. Thus, the long term use of metformin in women with PCOS should lessen their risk for both conditions, but further studies are required to confirm this potential in this specific group.