Cardiovascular Risk Factors and PCOS.

Patients with PCOS have abnormal lipid profile including elevated triglyceride, LDL-Cholesterol, VLDL-Cholesterol, apoB, and decreased HDL. These have been linked to cardiovascular disease, in general.

In a study of over 200 patients with PCOS, Talbott found increased BMI, insulin, triglyceride, cholesterol, LDL, and blood pressure. The elevated insulin levels were found to correlate with the increased cardiovascular risk independently in PCOS patients.

In a very interesting study by Birdsall and colleagues examining 143 women who had cardiac catheterization at less than 60 years of age 42% had PCOS. These patients had more extensive disease. Another study found 30% -40% of patients with PCOS had coronary artery calcifications which is consistent with potential cardiovascular disease.

A study of over 1400 Swedish patients found that the myocardial infarction risk rate was 4 fold higher in patients between 40 and 49 years of age and 11 fold higher in patients between 50 and 61 years of age.

Overall, these studies suggest that PCOS patients have increased risk for cardiovascular disease. Ultimately, more large prospective population based studies will be completed to lend more support to the assertion that cardiovascular risk is increased. Recently, small studies have been performed examining some of the presumed mediators of cardiovascular disease in younger women with PCOS compared to healthy controls. Endothelial dysfunction and chronic inflammation we suggested by elevations in several markers; endothelin-1, soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1 and highly sensitive C-Reactive Protein. These are consistent with a potential for vascular disease.

Insulin resistance leads to increased free fatty acids that in turn lead to increased muscle resistance to insulin, increased vasoconstriction of small blood vessels, increased insulin secretion by the pancreas and increased glucose release by the liver. Over time, these play a roll in the progression of cardiovascular disease. Interestingly, a study of metformin therapy for 6 months in patients with PCOS and insulin resistance showed an improvement in coronary flow reserve, suggesting improved coronary microvascular function.