Endocrine Abstracts (2011) 26 P109

PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis

P C M de Groot, O M Dekkers, J A Romijn, S W M Dieben & F M Helmerhorst


Leiden University Medical Center, Leiden, Netherlands.


Background: Patients suffering from polycystic ovarian syndrome (PCOS) are warned for arterial disease. We examined the risk of (non)fatal coronary heart disease (CHD) or stroke between PCOS patients and ovulatory, non-PCOS women. Further we assessed the effect of obesity on this risk

Methods: We performed a systematic review and meta-analysis of controlled observational studies. Four definitions of PCOS were considered: WHO type II anovulation (1976), NIH criteria (1990), Rotterdam consensus (2003) and Androgen-excess criteria in 2006. Obesity was defined as a BMI >30 kg/m2 and/or a waist circumference >88 cm. Study quality was assessed using the Newcastle–Ottawa Scale. Fatal and nonfatal CHD or stroke was the primary outcome. The definition of CHD and stroke was based on the criteria used by the various authors. The effect measure was the pooled relative risk in a random effects model. Risk ratios and rate ratios were combined in the present analysis.

Results: Five follow-up studies published between 2000 and 2008 were included. The studies showed heterogeneity in design, definitions and quality. In a random effects model the relative risk for CHD or stroke was 2.02 comparing PCOS women to non-PCOS women (95% ci 1.47, 2.76). Pooling the two studies with BMI adjusted risk estimates, showed a relative risk of 1.55 (1.27, 1.89).

Conclusions: This meta-analysis showed a two-fold risk of arterial disease for PCOS patients relative to non-PCOS patients. The risk remained increased after adjustment for BMI.

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