Evidence for an Association between Metabolic Cardiovascular Syndrome and Coronary and Aortic Calcification among Women with Polycystic Ovary Syndrome

Abstract

Women with polycystic ovary syndrome (PCOS) exhibit an adverse cardiovascular risk profile, characteristic of the metabolic cardiovascular syndrome (MCS). The aim of this study was to determine the prevalence of coronary artery (CAC) and aortic (AC) calcification among middle-aged PCOS cases and controls and to explore the relationship among calcification, MCS, and other cardiovascular risk factors assessed 9 yr earlier. This was a prospective study of 61 PCOS cases and 85 similarly aged controls screened in 1993-1994 for risk factors and reevaluated in 2001-2002. The main outcome measures were CAC and AC, measured by electron beam tomography. Women with PCOS had a higher prevalence of CAC (45.9% vs. 30.6%) and AC (68.9% vs. 55.3%) than controls. After adjustment for age and body mass index, PCOS was a significant predictor of CAC (odds ratio = 2.31; P = 0.049). PCOS subjects were also 4.4 times more likely to meet the criteria for MCS than controls. High-density lipoprotein cholesterol and insulin appeared to mediate the PCOS influence on CAC. Interestingly, total testosterone was an independent risk factor for AC in all subjects after controlling for PCOS, age, and body mass index (P = 0.034). We conclude that women with PCOS are at increased risk of MCS and demonstrate increased CAC and AC compared with controls. Components of MCS mediate the association between PCOS and CAC, independently of obesity.

Effects of an antiandrogenic oral contraceptive pill compared with metformin on blood coagulation tests and endothelial function in women with the polycystic ovary syndrome: influence of obesity and smoking

“…Cardiovascular risk markers (1-3) and early subclinical atherosclerosis (4,5) cluster in women with the polycystic ovary syndrome (PCOS) as a consequence of their hyperandrogenism and insulin-resistant metabolic milieu. The latter might lead to a prothrombotic state and to endothelial dysfunction (6,7), especially if amplified by the obesity (8,9) frequently associated with PCOS (10,11).…”

Serum concentrations of atherogenic proteins neutrophil gelatinase-associated lipocalin and its complex with matrix metalloproteinase-9 are significantly lower in women with polycystic ovary syndrome: hint of a protective mechanism?

“…Elegant studies have revealed that women suffering from PCOS exhibit a broad spectrum of metabolic abnormalities, predisposing them to increased cardiovascular risk such as insulin resistance, dyslipidemia, fibrinolytic aberrations, subclinical inflammation, and raised levels of markers of oxidative stress (2,3). Moreover, studies of endothelial function in this group of patients have disclosed the initiation of atherosclerotic process as evidenced by elevated levels of vasoconstrictive peptides, increased intima-media thickness of carotid arteries, disturbed endothelium-dependent flow-mediated dilatation of the arteries and increased coronary and aortic calcifications (4)(5)(6). Taking into account that these abnormalities are encountered as early as the second decade of life in patients with PCOS (7), these subjects represent significantly higher risk to develop cardiovascular incidents, in comparison with their age-and BMImatched peers.…”

Long-term consequences of polycystic ovary syndrome on cardiovascular risk

“…Alterations in both endothelium-dependent and independent vasodilator responses of the brachial artery in women with PCOS have been also reported (24)(25)(26)(27)(28). Further, morphological studies have shown that women with PCOS have increased carotid intima media thickness as well as higher incidence of coronary and aortic arterial calcification (29)(30)(31)(32). These reports are complemented with angiographic data in women showing an association between coronary artery disease and polycystic ovaries (33).…”