Comprehensive Meta-Analysis of Functional and Structural Markers of Subclinical Atherosclerosis in Women with Polycystic Ovary Syndrome

Abstract

The relationship between polycystic ovary syndrome (PCOS) and subclinical atherosclerosis remains unclear. We performed a comprehensive systematic review and meta-analysis to evaluate the effect of PCOS on functional and structural markers of subclinical atherosclerosis as measured by carotid intima-media thickness (cIMT), flow-mediated vasodilation (FMD), nitroglycerin-mediated vasodilation (NMD), pulse wave velocity (PWV), and coronary artery calcium (CAC). Standard mean differences (SMDs) or odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated. Ninety-six articles involving 5550 PCOS patients and 5974 controls were included. Compared with controls, PCOS patients showed significantly thicker cIMT (SMD (95% CI) = .587 (.398, .776), P < .001), lower FMD (SMD (95% CI) = −.649 (−.946, −.353), P < .001) and NMD (SMD (95% CI) = −.502 (−.686, −.317), P < .001), as well as higher PWV (SMD (95% CI) = .382 (.019, .746), P = .039), and increased CAC incidence (OR (95% CI) = 2.204 (1.687, 2.879), P < .001). When analyzing subgroups by age and body mass index (BMI), results were still significant ( P < .05) except for PWV in the BMI subgroup. There was no significant result on sensitivity analysis, and Begg’ test or Egger’s test. PCOS contributes to subclinical atherosclerosis, resulting in functional and structural changes in cIMT, FMD and NMD, PWV, and CAC incidence.

Possible Effect of Polycystic Ovary Syndrome (PCOS) on Cardiovascular Disease (CVD): An Update

“…It should be noted that other studies found a lack of association [60,61]. A recent meta-analysis included 96 studies (5550 PCOS women) and revealed that PCOS contributes to subclinical atherosclerosis [62], thus confirming a previous study that noted the high heterogeneity among studies [63].…”

The Current and Emerging Role of Statins in the Treatment of PCOS: The Evidence to Date

“…However, this risk does not consistently translate to an increased rate of cardiovascular events in the postmenopausal period. Studies have documented various preclinical changes in arterial structure among PCOS women of reproductive age [55]. A thorough systematic review and metaanalysis, encompassing 96 studies with 5550 PCOS patients and 5974 controls, sought to assess PCOS's impact on early indicators of atherosclerosis, using measurements like carotid intima-media thickness (cIMT), flow-mediated dilation (FMD), nitroglycerin-induced dilation (NMD), pulse wave velocity (PWV), and coronary artery calcium (CAC) [55].…”

“…Studies have documented various preclinical changes in arterial structure among PCOS women of reproductive age [55]. A thorough systematic review and metaanalysis, encompassing 96 studies with 5550 PCOS patients and 5974 controls, sought to assess PCOS's impact on early indicators of atherosclerosis, using measurements like carotid intima-media thickness (cIMT), flow-mediated dilation (FMD), nitroglycerin-induced dilation (NMD), pulse wave velocity (PWV), and coronary artery calcium (CAC) [55]. PCOS patients exhibited notably thicker cIMT, impaired FMD and NMD, increased PWV, and a higher rate of CAC compared to controls [55,56].…”