PDF herunterladen
Semin Reprod Med 2003; 21(3): 309-316
DOI: 10.1055/s-2003-43309
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Cardiovascular Health in Women with Polycystic Ovary Syndrome

Sara Sukalich, David Guzick
  • Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Oktober 2003 (online)

    Lizenzen und Reprints

ABSTRACT

Polycystic ovary syndrome (PCOS) is arguably the most common endocrinopathy among women of reproductive age. Women with PCOS have clinical characteristics that are associated with insulin resistance, vascular dysfunction, hypertension, and dyslipidemia. Although definitive data for increased cardiovascular events in women with PCOS are lacking, case-control studies have documented an increased risk of preclinical cardiovascular disease. Thus, PCOS should be viewed as a chronic condition that may ultimately have long-term health impacts and patients should be counseled to reduce cardiovascular risk factors through weight control, exercise, and/or pharmacologic treatments.

KEYWORDS

Polycystic ovary syndrome - cardiovascular disease - dyslipidemia - insulin resistance

REFERENCES

  • 1 Stein I F, Leventhal M L. Amenorrhea associated with bilateral polycystic ovaries.  Am J Obstet Gynecol . 1935;  29 181-191
    PubMedGoogle Scholar
  • 2 Knochenhauer E S, Key T J, Kahsar-Miller M. et al . Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study.  J Clin Endocrinol Metab . 1998;  83 3078-3082
    CrossrefPubMedGoogle Scholar
  • 3 Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis.  Endocr Rev . 1997;  18 774-800
    CrossrefPubMedGoogle Scholar
  • 4 Wild R, Painter P, Coulson P. et al . Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome.  J Clin Endocrinol Metab . 1985;  61 946-951
    CrossrefPubMedGoogle Scholar
  • 5 Talbott E, Guzick D, Clerici A. et al . Coronary heart disease risk factors in women with polycystic ovary syndrome.  Arterioscler Thromb Vasc Biol . 1995;  15 821-826
    CrossrefPubMedGoogle Scholar
  • 6 Mahabeer S, Naidoo C, Norman R. et al . Metabolic profiles and lipoprotein lipid concentrations in non-obese and obese patients with polycystic ovarian disease.  Horm Metab Res . 1990;  22 537-540
    PubMedGoogle Scholar
  • 7 Wild R, Bartholomew M. The influence of body weight on lipoprotein lipids in patients with polycystic ovary syndrome.  Am J Obstet Gynecol . 1988;  159 423-427
    PubMedGoogle Scholar
  • 8 Talbot E, Clerici A, Berga S. et al . Adverse lipid and coronary heart disease profiles in young women with polycystic ovary syndrome: results of a case-control study.  J Clin Epidemiol . 1998;  51 415-422
    CrossrefPubMedGoogle Scholar
  • 9 Dejager S, Pichard C, Bruckert E. et al . Smaller LDL particle size in women with polycystic ovary syndrome compared to controls.  Clin Endocrinol (Oxf) . 2001;  54 455-462
    CrossrefPubMedGoogle Scholar
  • 10 Austin M, Breslow J, Hennekens C. et al . Low-density lipoprotein subclass patterns and risk of myocardial infarction.  JAMA . 1988;  260 1917-1921
    CrossrefPubMedGoogle Scholar
  • 11 Slowinska-Srzednicka J, Zgliczynski S, Wierzbicki M. et al . The role of hyperinsulinemia in the development of lipid disturbances in nonobese and obese women with the polycystic ovary syndrome.  J Endocrinol Invest . 1991;  14 569-575
    PubMedGoogle Scholar
  • 12 Wild R, Alaupovic P, Parker I. Lipid and apolipoprotein abnormalities in hirsute women I: the association with insulin resistance.  Am J Obstet Gynecol . 1992;  166 1191-1197
    PubMedGoogle Scholar
  • 13 Reaven G, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities: the role of insulin resistance and the sympathoadrenal system.  N Engl J Med . 1996;  334 374-381
    CrossrefPubMedGoogle Scholar
  • 14 Talbott E, Zborowski J, Sutton-Tyrrell K. et al . Cardiovascular risk in women with polycystic ovary syndrome.  Obstet Gynecol Clin North Am . 2001;  28 111-133
    CrossrefPubMedGoogle Scholar
  • 15 Dahlgren E, Jahansson S, Lindstedt G. et al . Women with polycystic ovary syndrome wedge resected in 1956 to 1965; a long-term follow-up focusing on natural history and circulating hormones.  Fertil Steril . 1992;  57 505-513
    PubMedGoogle Scholar
  • 16 Rich-Edwards J, Solomon C, Dunaif A. et al .Associations of menstrual cycle characteristics with risk of hypertension in adult women. Presented at the 6th Annual Congress on Women's Health, Washington, DC, 1998
    Google Scholar
  • 17 Dunaif A, Segal K, Futterweit W. et al . Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome.  Diabetes . 1989;  38 1165-1174
    CrossrefPubMedGoogle Scholar
  • 18 BARI Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease.  N Engl J Med . 1996;  335 217-225
    CrossrefPubMedGoogle Scholar
  • 19 Dunaif A. Hyperandrogenic anovulation (PCOS): a unique disorder of insulin action associated with an increased risk of non-insulin-dependent diabetes mellitus.  Am J Med . 1995;  98 33S-39S
    PubMedGoogle Scholar
  • 20 Legro R, Kunselman A, Dodson W. et al . 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;  84 165-169
    CrossrefPubMedGoogle Scholar
  • 21 Solomon C, Rich-Edwards J, Dunaif A. et al .Abnormal menstrual cycle length predicts subsequent non-insulin-dependent diabetes mellitus. Presented at the 31st Annual Meeting of the Society for Epidemiologic Research, Chicago, IL, The Johns Hopkins University School of Hygiene and Public Health, 1998, p S60
    Google Scholar
  • 22 Mather K, Kwan F, Corenblum B. Hyperinsulinemia in polycystic ovary syndrome correlates with increased cardiovascular risk independent of obesity.  Fertil Steril . 2000;  73 150-156
    CrossrefPubMedGoogle Scholar
  • 23 Folsom A, Pankow J, Williams R. et al . Fibrinogen, plasminogen activator inhibitor-1, and carotid intima-media wall thickness in the NHLBI Family Heart Study.  Thromb Haemost . 1998;  79 400-404
    PubMedGoogle Scholar
  • 24 Talbott E, Zborowski J, Guzick D. et al .Increased PAI-1 levels in women with polycystic ovary syndrome: evidence for a specific "PCOS effect" independent of age and BMI. In: Programs and Abstracts of the 40th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, American Heart Association, San Diego, CA 2000, p 13
    Google Scholar
  • 25 Atiomo W, Fox R, Conodon J. et al . Raised plasminogen activator inhibitor-1 (PAI-1) is not an independent risk factor in the polycystic ovary syndrome (PCOS).  Clin Endocrinol (Oxf) . 2000;  52 487-492
    CrossrefPubMedGoogle Scholar
  • 26 Yarali H, Yildirir A, Aybar F. et al . Diastolic dysfunction and increase serum homocysteine concentrations may contribute to increased cardiovascular risk in patients with polycystic ovary syndrome.  Fertil Steril . 2001;  76 511-516
    CrossrefPubMedGoogle Scholar
  • 27 Guzick D, Talbott E, Sutton-Tyrrell K. et al . Carotid atherosclerosis in women with polycystic ovary syndrome: initial results from a case-control study.  Am J Obstet Gynecol . 1996;  174 1224-1232
    PubMedGoogle Scholar
  • 28 Young W, Goffman J, Tandy R. et al . The quantification of atherosclerosis, part III: the extent of correlation of degrees of atherosclerosis within and between the coronary and cerebral vascular beds. Am J Cardiol .  1960;  6 300-308
    PubMedGoogle Scholar
  • 29 Talbott E, Guzick D, Sutton-Tyrrell K. et al . Evidence for an association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women.  Arterioscler Thromb Vasc Biol . 2000;  20 2414-2421
    PubMedGoogle Scholar
  • 30 Rumberger J, Simon D, Fitzpatrick L. et al . Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study.  Circulation . 1995;  92 2157-2162
    CrossrefPubMedGoogle Scholar
  • 31 Wexler L, Brundage B, Crouse J. et al . Coronary artery calcification, pathophysiology, epidemiology, imaging methods and clinical implications.  Circulation . 1996;  94 1175-1192
    PubMedGoogle Scholar
  • 32 Christian R, Dumesic D, Yrtiska T. et al .Clinical hyperandrogenism and body mass index predict coronary calcification in premenopausal women with polycystic ovary syndrome. Presented at the Endocrine Society Annual Meeting, Toronto, Canada, June 21-24, 2000
    Google Scholar
  • 33 Harizi R, Bianco J, Alpert J. Diastolic dysfunction of the heart in clinical cardiology.  Arch Intern Med . 1988;  148 99-109
    CrossrefPubMedGoogle Scholar
  • 34 Paradisi G, Steinberg H O, Shepard M. et al .Polycystic ovary syndrome is associated with endothelial dysfunction. In: Programs and Abstracts of the 58th Annual Scientific Sessions of the ADA Diabetes 1998 47: A309
    Google Scholar
  • 35 Birdsall M, Farquhar C, White H. Association between polycystic ovaries and extent of coronary artery disease in women having cardiac catheterization.  Ann Intern Med . 1997;  126 32-35
    CrossrefPubMedGoogle Scholar
  • 36 Wild R, Grubb B, Hartz A. et al . Clinical signs of androgen excess as risk factors for coronary artery disease.  Fertil Steril . 1990;  54 254-259
    PubMedGoogle Scholar
  • 37 Pierpoint T, McKeigue P, Isaacs A. et al . Mortality of women with polycystic ovary syndrome at long-term follow-up.  J Clin Epidemiol . 1998;  51 581-586
    CrossrefPubMedGoogle Scholar
  • 38 Wild S, Pierpoint T, McKeigue P. et al . Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up a retrospective cohort study.  Clin Endocrinol (Oxf) . 2000;  52 595-600
    Google Scholar
  • 39 Adashi E, Rock J, Guzick D. et al . Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome.  Fertil Steril . 1981;  36 320-325
    PubMedGoogle Scholar
  • 40 Gjonnaess H. Late endocrine effects of ovarian electrocautery in women with polycystic ovary syndrome.  Fertil Steril . 1998;  69 697-701
    CrossrefPubMedGoogle Scholar