"Our findings indicate a strong correlation between PCOS, metabolic cardiovascular syndrome and initial evidence of calcium deposits that signal blood vessel disease," said Evelyn Talbott, Dr. P.H., professor of epidemiology and communication science at the University of Pittsburgh Graduate School of Public Health and the study's first author. "Given the large number of women with PCOS and the long incubation period for calcium accumulation in coronary arteries, early and aggressive intervention through lifestyle changes and medication may significantly reduce heart disease-related death and illness."
PCOS is a common disorder that affects up to 7 percent of the female population, or about 10 million women in the United States. Some estimates are that as many as 10 percent of reproductive-age women are affected by PCOS. Previously treated on a symptom-by-symptom basis by physicians unaware that a larger and more complicated ailment was present, PCOS today is increasingly being recognized as a lifelong hereditary reproductive endocrine condition with physical and emotional consequences. Common symptoms include infertility, irregular menstrual cycles, excess body hair, ovarian cysts, acne and obesity. The American Association of Clinical Endocrinologists issued a position paper just weeks ago to raise awareness of the disorder, saying that women with PCOS "are at greatest risk for diabetes and coronary artery disease."
Dr. Talbott's study involved 61 women with PCOS who underwent noninvasive electron beam tomography scanning of their coronary and abdominal arteries. Results for the 61 women with PCOS were compared with those for control subjects matched for age, race and body weight, and overall values were compared with recorded baseline measurements taken in 1992 and 1993, an average of nine years earlier. The heaviest women were excluded in order to make sure arterial changes correlated most closely with PCOS rather than other risk factors known to be associated with obesity.
"After adjustment for age and body-mass index, PCOS was a significant predictor of coronary-artery calcium deposits," said Dr. Talbott. "Women with PCOS were more than twice as likely to exhibit these subclinical arterial changes – that is, before symptoms appeared."
Women with PCOS who also had metabolic cardiovascular syndrome (MCS), which is associated with insulin resistance, increased waist size and high blood pressure, were found to be at an even greater risk of calcification in coronary and abdominal arteries, the study found. PCOS-affected women were more than four times more likely to have MCS than those in the control group who did not have PCOS.
"This is the first study to demonstrate a link between the specific components of MCS in younger women with PCOS and subsequent subclinical coronary atherosclerosis observed at the nine-year follow-up," she added.
Perhaps most interesting, however, was a finding that higher blood levels of testosterone were associated with increased risk of aortic calcifications in all women, whether they had an endocrine disorder or not. Earlier studies have noted such a correlation in women over the age of 55, but this study found a similar link in women in their 40s.
"These results are provocative and show the need for further investigation of testosterone and PCOS as the two relate to heart and blood vessel disease in later life," said Dr. Talbott.
Additional authors are Jeanne Zborowski, Ph.D., Judith Rager, M.P.H., and Monique Boudreaux, Ph.D., all of Pitt's Graduate School of Public Health; Daniel Edmundowicz, M.D., Pitt's School of Medicine; and David Guzick, M.D., Ph.D., University of Rochester School of Medicine. Funding for the study was provided by the National Heart Lung and Blood Institute of the National Institutes of Health.
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Journal
The Journal of Clinical Endocrinology & Metabolism