Doctors in a new study are suggesting that women diagnosed with a fairly common condition of reproductive age face a higher risk of developing cardiovascular disease in certain instances.¹

PCOS Intertwines with Insulin Resistance
The condition is known as polycystic ovary syndrome, or PCOS, regarded as the most common cause of infertility in women. Ovaries consist of follicles, fluid-filled sacs that mature and eventually break open to release the egg, beginning its journey down the fallopian tube toward the uterus. In women with PCOS, immature follicles cluster together to form large cysts in the ovary. While eggs mature within these clustered follicles, the follicles don't break open to release them. As a result, women with PCOS typically don’t have menstrual periods, or they have infrequent periods.²

PCOS is also characterized by other health complications, such as abnormally high levels of male hormones, as well as increased insulin, caused by insulin resistance.³ The latter also exists in people with a condition known as metabolic syndrome, which involves symptoms associated with type 2 diabetes, hypertension, and obesity. The metabolic syndrome is an umbrella term, also known as Syndrome X, that boosts the risk of heart disease, stroke, and diabetes. Other than women with PCOS, there are three groups of people at greater risk of developing the metabolic syndrome. Those include people with diabetes who cannot maintain normal levels of blood glucose, diabetics with high blood pressure who also produce large amounts of insulin to maintain blood glucose levels, and heart attack survivors with abnormally high insulin levels without glucose intolerance.⁴

Shared Features?
Since insulin resistance can be seen in both PCOS and metabolic syndrome, doctors wanted to know how prevalent metabolic syndrome is in women with PCOS.

After reviewing medical charts for 161 women, the study investigators led by John Nestler, MD, identified 106 females for the study. Forty-six of them had been diagnosed with both PCOS and the metabolic syndrome, and 60 of them had PCOS alone. Nestler, chairman of the division of Endocrinology and Metabolism at Virginia Commonwealth University, and his team analyzed all the patient data, and learned that 43 percent of the women with PCOS also had the metabolic syndrome. That was nearly twice the prevalence of the metabolic syndrome of women of the same age without PCOS in the general population, they reported.

This higher prevalence was also the case, regardless of age or body mass index (BMI), a medical term used to describe a person's healthy weight in relation to his or her height. Women with both PCOS and the metabolic syndrome also were found to have more severe insulin resistance.

Expanded Screenings May be Necessary in PCOS Women
"We conclude that the metabolic syndrome and its components are common in women with PCOS, placing them at increased risk for cardiovascular disease," Nestler and his team wrote.

"These findings indicate that women with PCOS should automatically be screened for the metabolic syndrome to prevent the risk of early-onset cardiovascular disease," Nestler said.

Another Perspective
Other medical experts have studied the association between PCOS and certain medical conditions that can lead to cardiovascular disease. In a prospective study published last year,⁵ a group of epidemiologists at the University of Pittsburgh took this a step further. They wanted to determine how often a key sign of cardiovascular disease—coronary calcification—is found in women with PCOS.

Coronary calcification refers to the buildup of calcium in the blood vessels, formed over time by plaque deposits that increase the risk of obstructing blood flow. Coronary calcification is a specific indicator of coronary artery disease.⁶

Patients in this study were divided into two groups. One included women with PCOS and the second group consisted of women without the condition. Each woman was screened, and then followed for nearly ten years. Coronary calcification was measured at both the start of the study in 1993, and again at the end of the research in 2002 as a comparison.

The research team found that PCOS was a significant predictor of coronary calcification. Women with PCOS were more than four times more likely to "meet the criteria for metabolic cardiovascular syndrome" than women without PCOS, according to the researchers. "Components of metabolic cardiovascular syndrome mediate the association between PCOS and coronary artery calcification, independently of obesity," wrote the researchers.

This calcification, which was also found in the aortas of women with PCOS in the study, is promoted by higher insulin and cholesterol levels, they stated.

1. Apridonidze T, Essah PA, Iurono MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005 Apr;90(4):1929-35. Epub 2004 Dec 28.
2. National Institute of Child Health & Human Development. National Institutes of Health (NIH). Disorders Associated with Infertility. Available at: http://www.nichd.nih.gov/womenshealth/infertility.cfm. Accessed August 9, 2005.
3. Pelusi C, Pasquali R. Polycystic ovary syndrome in adolescents: pathophysiology and treatment implications. Treat Endocrinol 2003;2(4):215-30.
4. Metabolic Syndrome. The Cleveland Clinic. Available at: http://www.clevelandclinic.org/health/health-info/docs/3000/3057.asp?index=10783. Accessed August 16, 2005.
5. Talbott EO, Zborowski JV, Rager JR, Boudreaux MY, Edmundowicz DA, Guzick DS. Evidence for an association between metabolic cardiovascular syndrome and coronary and aortic calcification among women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004 Nov;89(11):5454-61.
6. Schmermund A, Baumgart D, Erbel R. Coronary calcification by electron beam tomography: comparison with coronary risk factors and angiography. J Cardiovasc Risk 2000 Apr;7(2):99-106.