| OB/GYN News Sept 1, 2000 Experts Still Debate the Long-Term Cardiovascular Effects of PCOS. Author/s: Bruce Jancin TORONTO -- The question of whether polycystic ovary syndrome is associated with an increased long-term cardiovascular event rate has emerged as a major area of controversy Dr. Rogerio A. Lobo said at the annual. meeting of the Endocrine Society. In his evidence-based review of the long-term consequences of polycystic ovary syndrome (PCOS), he found convincing evidence that PCOS sharply increases a woman s risk of type 2 diabetes. The disorder is also characteristically associated with hypertriglyceridemia, low HDL cholesterol, obesity, and a threefold elevated risk of endometrial cancer. There is no indication of an increased risk of breast cancer. Limited and conflicting data point to a possible PCOS-related increase in ovarian cancer. Hypertension, although common in the PCOS population, is not intrinsic to the disorder; rather, it appears to be a byproduct of the obesity that's so often part of the syndrome, said Dr. Lobo, who is professor of ob.gyn. at Columbia University, New York. The anovulation of PCOS is improved by control of the syndrome's metabolic abnormalities, such as through the use of insulin-sensitizing agents. Nonetheless, 30%-40% of PCOS patients who do become pregnant miscarry. And complications of pregnancy are increased across the board in PCOS patients: Rates of pregnancy-induced hypertension, gestational diabetes, stillbirths, and preterm labor are all elevated. It appears that many of the common metabolic derangements seen in PCOS also occur, albeit in a milder form, in the many women who have polycystic ovaries without amenorrhea or obesity. Dr. Lobo's study showed that many women who simply have polycystic ovaries also have the reduced I-IDL cholesterol, high triglycerides, and diminished insulin sensitivity characteristic of full-blown PCOS. "Modification of long-term risk of PCOS by early treatment and pregnancy have to be factored in terms of what the final outcome will be. Because of that, my philosophy is that one needs to identify these women--whether they have polycystic ovaries or the full-blown syndrome--identify what risk factors they have at the time, and follow them closely, essentially forever," Dr. Lobo said. As to whether increased cardiovascular risk is a consequence of PCOS, "I think we really don't know. Current data would suggest no, except in the diabetics," the ob.gyn. said. He cited a recent 32-year follow-up study of more than 700 English women who had been diagnosed with PCOS at a mean age of 25 years. The study by Dr. Howard S. Jacobs and associates of London found no increase in coronary heart disease morbidity and mortality, compared with age-matched controls, despite the PCOS group's high level of cardiovascular risk factors- raising the possibility that something about PCOS might be cardioprotective. But Dr. Andrea Dunaif rose from the audience to say that new data from the Nurses' Health Study, using a far larger sample size than in Dr. Jacobs' study did show a statistically significant 50% increase in the relative risk of coronary events in women who reported having menses less frequently than every 40 days, which was used as a surrogate for PCOS. This was true after adjusting for body weight, oral contraceptive use, and number of pregnancies, added Dr. Dunaif, chief of the division of women's health at Brigham and Women's Hospital and director of the national center of excellence in women's health at Harvard Medical School, Boston. Dr. Rose C. Christian, too, was critical of the British study in an interview with this newspaper. She cited two concerns: the study's retrospective nature, and the fact that participants were diagnosed more than 30 years ago in an era before the diagnosis could be reliably made. "Lots of these women probably didn't have PCOS," said Dr. Christian of the Mayo Clinic, Rochester, Minn. She presented an electron beam CT coronary artery calcification study involving 32 PCOS patients with an average age of 40 years, as well as 52 ovulatory controls matched by age and body mass index. Coronary artery calcification indicative of significant atherosclerosis was present in 36% of the PCOS group, a prevalence 2.5-fold greater than in controls. Moreover, the prevalence was 5.5-fold greater among PCOS patients than in a community database comprising roughly 600 individuals of similar age. But the most striking finding was that the PCOS patients' rate of significant coronary artery calcification was the same as in same-aged men in the community. By age 40, Dr. Christian noted, these women had lost the gender-based protection against coronary disease that in normal women extends beyond menopause. ------------------------------------------------------------------------------- COPYRIGHT 2000 International Medical News Group in association with The Gale Group and LookSmart. COPYRIGHT 2001 Gale Group ------------------------------------------------------------------------------- |
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