Background: Polycystic ovary syndrome (PCOS) is characterised by a high prevalence of obesity and insulin resistance, leading to an increased risk of type 2 diabetes. However, it is unclear whether cardiovascular risk (CVR) is increased in PCOS independently of these metabolic disturbances.
Aims: To establish whether PCOS is associated with arterial stiffness, carotid intima media thickness (cIMT) and myocardial dysfunction, and explore the relationships of these CVR markers with body composition and insulin sensitivity.
Methods: Subcutaneous and visceral fat (VF) area was measured by CT. Insulin sensitivity was established by insulin response (IAUC) following glucose challenge. Arterial stiffness (aortic pulse wave velocity (aPWV), cIMT and tissue Doppler-derived diastolic (e:a) myocardial velocities were used as surrogate markers of CVR.
Results: 84 women with PCOS and 95 healthy volunteers (HV) (age 1645) were included. After adjustment for age and BMI, PCOS subjects had higher IAUC (adjusted difference (AD) 35950 pmol min/l, P<0.001), testosterone (AD 0.57 nmol/l, P<0.001) and adiponectin (AD 3.01 μg/ml, P=0.02), but no significant differences in aPWV (AD −0.13 m/s, P=0.33), cIMT (AD −0.01 mm, P=0.13) or e:a (AD −0.01, P=0.86). In regression analyses, after adjustment for age, height and central pulse pressure, e:a (standardised regression coefficient (SRC) −0.391, P<0.0001) and aPWV (SRC 0.293, P<0.0001) were associated with logVF but the association between logVF and cIMT was not significant (SRC 0.078, P=0.28). e:a (SRC −0.469, P<0.0001) and aPWV (SRC 0.31, P<0.0001) were also independently associated with IAUC. The relationships between e:a or aPWV and logVF were only partly attenuated by adjusting for insulin sensitivity (e:a SRC −0.173, P<0.0001and aPWV SRC 0.214, P=0.015). There was no significant relationship between a PWV or e:a and either testosterone or adiponectin.
Conclusions: Insulin resistance and central obesity are associated with subclinical cardiovascular dysfunction in young women. A diagnosis of PCOS does not confer additional risk.