Generic placeholder image

Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Review Article

Cardiovascular Risk in Postmenopausal Women with Polycystic Ovary Syndrome

Author(s): Eleni Armeni and Irene Lambrinoudaki*

Volume 17, Issue 6, 2019

Page: [579 - 590] Pages: 12

DOI: 10.2174/1570161116666180828154006

Price: $65

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting women of reproductive age. The hormonal alterations of PCOS have been linked with a higher risk of metabolic disturbances in young, reproductively active women. However, it remains to be clarified whether the presence of PCOS increases the risk of cardiovascular disease (CVD) later in life. Aging ameliorates the clinical manifestations of PCOS; hyperandrogenaemia and metabolic abnormalities, however, persist beyond the menopause. On the other hand, aging and menopause increase CVD risk in the general female population. The results of the limited available studies in aging women with a previous diagnosis of PCOS demonstrate early atherosclerosis. However, studies addressing clinical CVD outcomes in women with PCOS report inconsistent findings. A possible explanation for this heterogeneity is the difficulty in diagnosing PCOS after the menopausal transition, due to the absence of validated diagnostic criteria for this population. Larger prospective studies of women diagnosed during their reproductive years will shed more light on the longer-term CVD implications of PCOS.

Keywords: Cardiovascular risk, menopause, PCOS, MetS, dyslipidaemia, diabetes mellitus, subclinical atherosclerosis, clinical cardiovascular disease.

Graphical Abstract
[1]
Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: A consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 95: 2038-49.
[2]
Fauser BC, Tarlatzis BC, Rebar RW, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012; 97: 28-38.
[3]
Dewailly D, Catteau-Jonard S, Reyss AC, Leroy M, Pigny P. Oligoanovulation with polycystic ovaries but not overt hyperandrogenism. J Clin Endocrinol Metab 2006; 91: 3922-7.
[4]
Hsu MI. Changes in the PCOS phenotype with age. Steroids 2013; 78: 761-6.
[5]
Pinola P, Piltonen TT, Puurunen J, et al. Androgen profile through life in women with polycystic ovary syndrome: A nordic multicenter collaboration study. J Clin Endocrinol Metab 2015; 100: 3400-7.
[6]
Lambrinoudaki I. Cardiovascular risk in postmenopausal women with the polycystic ovary syndrome. Maturitas 2011; 68: 13-6.
[7]
Pucci G, Alcidi R, Tap L, Battista F, Mattace-Raso F, Schillaci G. Sex- and gender-related prevalence, cardiovascular risk and therapeutic approach in metabolic syndrome: A review of the literature. Pharmacol Res 2017; 120: 34-42.
[8]
Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update 2010; 16: 347-63.
[9]
Bentley-Lewis R, Seely E, Dunaif A. Ovarian hypertension: Polycystic ovary syndrome. Endocrinol Metab Clin North Am 2011; 40: 433-49.
[10]
Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, et al. The risk of metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2018; 88: 169-84.
[11]
Mahalingaiah S, Diamanti-Kandarakis E. Targets to treat metabolic syndrome in polycystic ovary syndrome. Expert Opin Ther Targets 2015; 19: 1561-74.
[12]
Boumosleh JM, Grundy SM, Phan J, Neeland IJ, Chang A, Vega GL. Metabolic concomitants of obese and nonobese women with features of polycystic ovarian syndrome. J Endocr Soc 2017; 1: 1417-27.
[13]
Baldani DP, Skrgatic L, Ougouag R. Polycystic ovary syndrome: Important underrecognised cardiometabolic risk factor in reproductive-age women. Int J Endocrinol 2015.786362
[14]
Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999; 22: 141-6.
[15]
Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: A prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999; 84: 165-9.
[16]
Velija-Asimi Z, Burekovic A, Dujic T, Dizdarevic-Bostandzic A, Semiz S. Incidence of prediabetes and risk of developing cardiovascular disease in women with polycystic ovary syndrome. Bosn J Basic Med Sci 2016; 16: 298-306.
[17]
Rubin KH, Glintborg D, Nybo M, Abrahamsen B, Andersen M. Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2017; 102: 3848-57.
[18]
Wang ET, Calderon-Margalit R, Cedars MI, et al. Polycystic ovary syndrome and risk for long-term diabetes and dyslipidemia. Obstet Gynecol 2011; 117: 6-13.
[19]
Ollila ME, West S, Keinanen-Kiukaanniemi S, et al. Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus-a prospective, population-based cohort study. Hum Reprod 2017; 32: 423-31.
[20]
Daan NM, Louwers YV, Koster MP, et al. Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: Who is really at risk? Fertil Steril 2014; 102: 1444-51.
[21]
Puurunen J, Piltonen T, Jaakkola P, Ruokonen A, Morin-Papunen L, Tapanainen JS. Adrenal androgen production capacity remains high up to menopause in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2009; 94: 1973-8.
[22]
Ramezani Tehrani F, Montazeri SA, Hosseinpanah F, et al. Trend of cardio-metabolic risk factors in polycystic ovary syndrome: A population-based prospective cohort study. PLoS One 2015; 10e0137609
[23]
Markopoulos MC, Valsamakis G, Kouskouni E, et al. Study of carbohydrate metabolism indices and adipocytokine profile and their relationship with androgens in polycystic ovary syndrome after menopause. Eur J Endocrinol 2012; 168: 83-90.
[24]
Huddleston HG, Quinn MM, Kao CN, Lenhart N, Rosen MP, Cedars MI. Women with polycystic ovary syndrome demonstrate worsening markers of cardiovascular risk over the short-term despite declining hyperandrogenaemia: Results of a longitudinal study with community controls. Clin Endocrinol (Oxf) 2017; 87: 775-82.
[25]
Carmina E, Campagna AM, Lobo RA. A 20-year follow-up of young women with polycystic ovary syndrome. Obstet Gynecol 2012; 119: 263-9.
[26]
Alsamarai S, Adams JM, Murphy MK, et al. Criteria for polycystic ovarian morphology in polycystic ovary syndrome as a function of age. J Clin Endocrinol Metab 2009; 94: 4961-70.
[27]
Livadas S, Kollias A, Panidis D, Diamanti-Kandarakis E. Diverse impacts of aging on insulin resistance in lean and obese women with polycystic ovary syndrome: Evidence from 1345 women with the syndrome. Eur J Endocrinol 2014; 171: 301-9.
[28]
Schmidt J, Landin-Wilhelmsen K, Brannstrom M, Dahlgren E. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: A 21-year controlled follow-up study. J Clin Endocrinol Metab 2011; 96: 3794-803.
[29]
Comim FV, Wippel CS, Copes RM, et al. Higher prevalence of clinical cardiovascular comorbidities in postmenopausal women with self-reported premenopausal hirsutism and/or oligo-amenorrhea. Dermatoendocrinol 2017; 9e1356517
[30]
Shi Y, Cui Y, Sun X, et al. Hypertension in women with polycystic ovary syndrome: Prevalence and associated cardiovascular risk factors. Eur J Obstet Gynecol Reprod Biol 2014; 173: 66-70.
[31]
Joham AE, Boyle JA, Zoungas S, Teede HJ. Hypertension in reproductive-aged women with polycystic ovary syndrome and association with obesity. Am J Hypertens 2015; 28: 847-51.
[32]
Elci E, Kaya C, Cim N, Yildizhan R, Elci GG. Evaluation of cardiac risk marker levels in obese and non-obese patients with polycystic ovaries. Gynecol Endocrinol 2017; 33: 43-7.
[33]
Polotsky HN, Polotsky AJ. Metabolic implications of menopause. Semin Reprod Med 2010; 28: 426-34.
[34]
Ezeh U, Pall M, Mathur R, Azziz R. Association of fat to lean mass ratio with metabolic dysfunction in women with polycystic ovary syndrome. Hum Reprod 2014; 29: 1508-17.
[35]
Karabulut A, Yaylali GF, Demirlenk S, Sevket O, Acun A. Evaluation of body fat distribution in PCOS and its association with carotid atherosclerosis and insulin resistance. Gynecol Endocrinol 2012; 28: 111-4.
[36]
Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med 2001; 111: 607-13.
[37]
Glintborg D, Mumm H, Hougaard D, Ravn P, Andersen M. Ethnic differences in Rotterdam criteria and metabolic risk factors in a multiethnic group of women with PCOS studied in Denmark. Clin Endocrinol 2010; 73: 732-8.
[38]
Diamanti-Kandarakis E, Papavassiliou AG, Kandarakis SA, Chrousos GP. Pathophysiology and types of dyslipidemia in PCOS. Trends Endocrinol Metab 2007; 18: 280-5.
[39]
Macut D, Panidis D, Glisic B, et al. Lipid and lipoprotein profile in women with polycystic ovary syndrome. Can J Physiol Pharmacol 2008; 86: 199-204.
[40]
Wang Q, Ferreira DLS, Nelson SM, Sattar N, Ala-Korpela M, Lawlor DA. Metabolic characterization of menopause: Cross-sectional and longitudinal evidence. BMC Med 2018; 16: 17.
[41]
Meyer ML, Malek AM, Wild RA, Korytkowski MT, Talbott EO. Carotid artery intima-media thickness in polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update 2012; 18: 112-26.
[42]
Yilmaz SA, Kebapcilar A, Koplay M, et al. Association of clinical androgen excess with radial artery intima media thickness in women with polycystic ovary syndrome. Gynecol Endocrinol 2015; 31: 477-82.
[43]
Gencer M, Gazi E, Hacivelioglu S, et al. The relationship between subclinical cardiovascular disease and lipocalin-2 levels in women with PCOS. Eur J Obstet Gynecol Reprod Biol 2014; 181: 99-103.
[44]
Karoli R, Fatima J, Siddiqi Z, Vatsal P, Sultania AR, Maini S. Study of early atherosclerotic markers in women with polycystic ovary syndrome. Indian J Endocrinol Metab 2012; 16: 1004-8.
[45]
Allameh Z, Rouholamin S, Adibi A, Mehdipour M, Adeli M. Does carotid intima-media thickness have relationship with polycystic ovary syndrome? Int J Prev Med 2013; 4: 1266-70.
[46]
Mohammadi A, Aghasi M, Jodeiry-Farshbaf L, Salary-Lac S, Ghasemi-Rad M. Evaluation of early atherosclerotic findings in women with polycystic ovary syndrome. J Ovarian Res 2011; 4: 1757-2215.
[47]
Guleria AK, Syal SK, Kapoor A, Kumar S, Tiwari P, Dabadghao P. Cardiovascular disease risk in young Indian women with polycystic ovary syndrome. Gynecol Endocrinol 2014; 30: 26-9.
[48]
Patel SS, Truong U, King M, et al. Obese adolescents with polycystic ovarian syndrome have elevated cardiovascular disease risk markers. Vasc Med 2017; 22: 85-95.
[49]
Coksuer H, Koplay M, Oghan F, Haliloglu B, Keskin N. Evaluation of carotid wall thickness and vertebro-basilar system insufficiency in patients with obese polycystic ovary syndrome. J Obstet Gynaecol Res 2011; 37: 997-1003.
[50]
Calderon-Margalit R, Siscovick D, Merkin SS, et al. Prospective association of polycystic ovary syndrome with coronary artery calcification and carotid-intima-media thickness: The coronary artery risk development in young adults women’s study. Arterioscler Thromb Vasc Biol 2014; 34: 2688-94.
[51]
Kahal H, Aburima A, Ungvari T, et al. Polycystic ovary syndrome has no independent effect on vascular, inflammatory or thrombotic markers when matched for obesity. Clin Endocrinol (Oxf) 2013; 79: 252-8.
[52]
Barcellos CR, Lage SH, Rocha MP, et al. Polycystic ovary syndrome and obesity do not affect vascular parameters related to early atherosclerosis in young women without glucose metabolism disturbances, arterial hypertension and severe abnormalities of lipid profile. Gynecol Endocrinol 2013; 29: 370-4.
[53]
Hughan KS, Tfayli H, Warren-Ulanch JG, Barinas-Mitchell E, Arslanian SA. Early biomarkers of subclinical atherosclerosis in obese adolescent girls with polycystic ovary syndrome. J Pediatr 2016; 168: 104-11.
[54]
Kim JJ, Choi YM, Kang JH, et al. Carotid intima-media thickness in mainly non-obese women with polycystic ovary syndrome and age-matched controls. Obstet Gynecol Sci 2013; 56: 249-55.
[55]
Lebkowska A, Adamska A, Jacewicz M, et al. Association between polycystic ovary syndrome and the risk of subclinical vascular disease in normalweight women with type 1 diabetes. Pol Arch Intern Med 2017; 127: 741-8.
[56]
Dube R. Does endothelial dysfunction correlate with endocrinal abnormalities in patients with polycystic ovary syndrome? Avicenna J Med 2016; 6: 91-102.
[57]
Sprung VS, Atkinson G, Cuthbertson DJ, et al. Endothelial function measured using flow-mediated dilation in polycystic ovary syndrome: A meta-analysis of the observational studies. Clin Endocrinol (Oxf) 2013; 78: 438-46.
[58]
Sprung VS, Jones H, Pugh CJ, et al. Endothelial dysfunction in hyperandrogenic polycystic ovary syndrome is not explained by either obesity or ectopic fat deposition. Clin Sci 2014; 126: 67-74.
[59]
Lambert EA, Teede H, Sari CI, et al. Sympathetic activation and endothelial dysfunction in polycystic ovary syndrome are not explained by either obesity or insulin resistance. Clin Endocrinol (Oxf) 2015; 83: 812-9.
[60]
Meyer ML, Tepper PG, Barinas-Mitchell E, Korytkowski MT, Talbott EO. Varying patterns of brachial artery flow-mediated dilatation in women with polycystic ovary syndrome and controls: An application of the group-based trajectory modeling. J Clin Ultrasound 2016; 44: 46-54.
[61]
Yavuz Taslipinar M, Kilic N, Bayraktar N, et al. Endothelial dysfunction and insulin resistance in young women with polycystic ovarian syndrome. Turk J Med Sci 2014; 44: 787-91.
[62]
Bayram F, Kocer D, Ozsan M, Muhtaroglu S. Evaluation of endothelial dysfunction, lipid metabolism in women with polycystic ovary syndrome: Relationship of paraoxonase 1 activity, malondialdehyde levels, low-density lipoprotein subfractions, and endothelial dysfunction. Gynecol Endocrinol 2012; 28: 497-501.
[63]
Soyman Z, Noyan V, Tulmac M, et al. Serum paraoxonase 1 activity, asymmetric dimethylarginine levels, and brachial artery flow-mediated dilatation in women with polycystic ovary syndrome. Fertil Steril 2011; 95: 1067-72.
[64]
Rees E, Coulson R, Dunstan F, et al. Central arterial stiffness and diastolic dysfunction are associated with insulin resistance and abdominal obesity in young women but polycystic ovary syndrome does not confer additional risk. Hum Reprod 2014; 29: 2041-9.
[65]
Armeni E, Stamatelopoulos K, Rizos D, et al. Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype. J Hypertens 2013; 31: 1998-2004.
[66]
Meun C, Franco OH, Dhana K, et al. High androgens in postmenopausal women and the risk for atherosclerosis and cardiovascular disease: The rotterdam study. J Clin Endocrinol Metab 2018; 1: 2017-421.
[67]
Azour L, Kadoch MA, Ward TJ, Eber CD, Jacobi AH. Estimation of cardiovascular risk on routine chest CT: Ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges. J Cardiovasc Comput Tomogr 2017; 11: 8-15.
[68]
Hsu CH, Chang SG, Hwang KC, Kuo CF, Chang HH, Chou PH. The impact of the menopause on coronary artery calcification examined by multislice computed tomography scanning. Nutr Metab Cardiovasc Dis 2008; 18: 306-13.
[69]
Snyder ML, Shields KJ, Korytkowski MT, Sutton-Tyrrell K, Talbott EO. Complement protein C3 and coronary artery calcium in middle-aged women with polycystic ovary syndrome and controls. Gynecol Endocrinol 2014; 30: 511-5.
[70]
Zoet GA, Meun C, Benschop L, et al. Cardiovascular riskprofile - imaging and gender-specific disorders (CREw-IMAGO): Rationale and design of a multicenter cohort study. BMC Womens Health 2017; 17: 60.
[71]
de Groot PC, Dekkers OM, Romijn JA, Dieben SW, Helmerhorst FM. PCOS, coronary heart disease, stroke and the influence of obesity: A systematic review and meta-analysis. Hum Reprod Update 2011; 17495-500.
[72]
Anderson SA, Barry JA, Hardiman PJ. Risk of coronary heart disease and risk of stroke in women with polycystic ovary syndrome: A systematic review and meta-analysis. Int J Cardiol 2014; 176: 486-7.
[73]
Zhao L, Zhu Z, Lou H, et al. Polycystic ovary syndrome (PCOS) and the risk of coronary heart disease (CHD): A meta-analysis. Oncotarget 2016; 7: 33715-21.
[74]
Glintborg D, Rubin KH, Nybo M, Abrahamsen B, Andersen M. Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome. Cardiovasc Diabetol 2018; 17: 37.
[75]
Ding DC, Tsai IJ, Wang JH, Lin SZ, Sung FC. Coronary artery disease risk in young women with polycystic ovary syndrome. Oncotarget 2018; 9: 8756-64.
[76]
Merz CN, Shaw LJ, Azziz R, et al. Cardiovascular disease and 10-year mortality in postmenopausal women with clinical features of polycystic ovary syndrome. J Womens Health 2016; 25: 875-81.
[77]
Iftikhar S, Collazo-Clavell ML, Roger VL, et al. Risk of cardiovascular events in patients with polycystic ovary syndrome. Neth J Med 2012; 70: 74-80.
[78]
Mani H, Levy MJ, Davies MJ, et al. Diabetes and cardiovascular events in women with polycystic ovary syndrome: A 20-year retrospective cohort study. Clin Endocrinol (Oxf) 2013; 78: 926-34.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy