Polycystic Ovary Syndrome: A Common Endocrine Disorder and Risk Factor for Vascular Disease


Opinion statement

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of reproductive age, impacting 5–10% of premenopausal American women. During the reproductive years, women with PCOS seek medical attention related to infertility, hirsutism, and acne. About 60% of women with PCOS are obese and insulin resistant. Up to 40% of women with PCOS will develop diabetes by the age of 50 and many are dyslipidemic. In addition to treating the cosmetic and fertility issues associated with PCOS, health care providers must educate patients regarding the long-term cardiovascular consequences associated the this disorder. At menopause, a woman with PCOS is likely to have had multiple cardiac risk factors for several decades. Postmenopausal women with a history of PCOS, especially those with established diabetes and/or dyslipidemia, should be considered at high risk for the development of clinical cardiac disease. Exercise and a prudent calorie-restricted diet aimed at weight loss must be stressed early. Pharmacologic therapy for diabetes and hyperlipidemia should be used when appropriate. Bariatric surgery, known to positively impact all the aforementioned cardiac risk factors, may also be of benefit.

References and Recommended Reading

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  1. 1.
    Stein IF, Leventhal ML. Amenorhoea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181–6.Google Scholar
  2. 2.
    Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, Merriam GR, editors. Polycystic ovary syndrome. Oxford: Blackwell; 1992. p. 59–69.Google Scholar
  3. 3.
    Revised 2003 consenseus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Fertil Steril 2004;81:19–25.Google Scholar
  4. 4.
    Azziz R, Carmina E, Dewailly D, et al. Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. Androgen Excess Society. J Clin Endocrinol Metab. 2006;91:4237–45.PubMedCrossRefGoogle Scholar
  5. 5.••
    Westerveld HE, Hoogendoorn M, de Jong AWF, et al. Cardiometabolic abnormalities in the polycystic ovary syndrome: pharmacotherapeutic insights. Pharmacol Ther. 2008;119:223–41.PubMedCrossRefGoogle Scholar
  6. 6.
    Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for the pathogenesis. Endocr Rev. 1997;18:774–800.PubMedCrossRefGoogle Scholar
  7. 7.
    Ehrmann DA, Barnes RB, Rosenfield RL, et al. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999;22:141–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Diamanti-Kandarakis E, Kandaraki E, Christakou C, Panidis D. The effect of pharmaceutical intervention on lipid profile in polycystic ovary syndrome. Obes Rev. 2009;10:431–41.PubMedCrossRefGoogle Scholar
  9. 9.
    Berneis K, Rizzo M, Lazzarini V, et al. Atherogenic lipoprotein phenotype and low-density lipoprotein size and subclasses in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2007;92:186–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Dokras A, Jagasia DH, Maifeld M, et al. Obesity/insulin resistance but not hyperandrogenism is an important mediator of vascular dysfunction in women with PCOS. Fertil Steril. 2006;86:1702–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Talbott EO, Guzick DS, Sutton-Tyrell, et al. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol. 2000;20:2414–21.PubMedCrossRefGoogle Scholar
  12. 12.••
    Talbott EO, Zborowski J, Rager J, Stragand JR. Is there and independent effect of polycystic ovary syndrome (PCOS) and menopause on the prevalence of subclinical atherosclerosis in middle aged women. Vasc Health Risk Manag. 2008;4(2):453–62.PubMedGoogle Scholar
  13. 13.
    Solomon CG, Hu FB, Dunaif A, et al. Menstrual cycle irregularity and the risk for future cardiovascular disease. J Clin Endocrinol Metab. 2002;87:2013–7.PubMedCrossRefGoogle Scholar
  14. 14.••
    Shaw LJ, Bairey Merz CN, Azziz R, et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survivalL results from the National Institutes of Health—National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE). J Clin Endocrinol Metab. 2008;93:1276–84.PubMedCrossRefGoogle Scholar
  15. 15.
    Pollack A. FDA fails to approve diet drug. The New York Times Feb 2, 2011: B1,4.Google Scholar
  16. 16.
    Gambineri A, Patton L, Vaccina A, et al. Treatment with flutamide, metformin, and their combination added to a hypocaloric diet in overweight-obese women with polycystic ovary syndrome: a randomized, 12-month, placebo-controlled study. J Clin Endocrinol Metab. 2006;91:3970–80.PubMedCrossRefGoogle Scholar
  17. 17.
    Lindholm A, Bixo M, Bjorn I, et al. Effect of sibutramine on weight reduction in women with polycystic ovary syndrome: a randomized double-blind, placebo-controlled trial. Fertil Steril. 2008;89:1221–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish and Learn diest for change in weight and related risk factors among overweight premenopausal women: the A to Z Weight Loss Study: a randomized trial. JAMA. 2007;297:969–77.PubMedCrossRefGoogle Scholar
  19. 19.
    Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859–73.PubMedCrossRefGoogle Scholar
  20. 20.•
    Look AHEAD Research Group, Pi-Sunyer X, Blackburn G, Brancati FL, et al. Reduction in weight and cardiovascular risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care. 2007;30:1374–83.PubMedCrossRefGoogle Scholar
  21. 21.
    Wing RR. Reduction in weight and cardiovascular (CVD) risk factors in subjects with type 2 diabetes (T2DM): four year results of Look AHEAD [abstract]. Obesity. 2009;17:S49.CrossRefGoogle Scholar
  22. 22.
    Wadden TA, Wing RR, Ryan DH, Neiberg R. Four-year weight losses in individuals with type 2 diabetes in the Look AHEAD [abstract]. Obesity. 2009;17:S76.CrossRefGoogle Scholar
  23. 23.
    Tang T, Glanville J, Hayden CJ, et al. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized, placebo-controlled, double-blind multicentre study. Hum Reprod. 2006;21:80–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Hoeger K, Davidson K, Kochman L, et al. The impact of metformin, oral contraceptives and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. J Clin Endocrinol Metab. 2008;93:4299–306.PubMedCrossRefGoogle Scholar
  25. 25.
    Moghetti P, Castello R, Negri C, et al. Metformin effects on clinical featueres, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized double-blind, placebo-controlled 6 month trial, followed by open, long-term clinical evaluation. J Clin Endocrinol Metab. 2000;85:139–46.PubMedCrossRefGoogle Scholar
  26. 26.
    Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.CrossRefGoogle Scholar
  27. 27.
    O’Keefe JH, Bell DS, Wyne KL. Glycemic control in type 2 diabetes. In: O’Keefe JH, Bell DS, Wyne KL, editors. Diabetes essentials. Sudbury: Jones and Bartlett; 2009. p. 63–92.Google Scholar
  28. 28.
    AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract. 2007;13 Suppl 1:1–68.Google Scholar
  29. 29.
    American Diabetes Association. Standards of medical care in diabetes mellitus. Diabetes Care. 2010;33 Suppl 1:11–61.CrossRefGoogle Scholar
  30. 30.
  31. 31.
    Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet. 2002;360:7–22.CrossRefGoogle Scholar
  32. 32.
    Bays HE, Goldberg RB, Truitt KE, Jones MR. Colesevelam hydrochloride therapy in patients with type 2 diabetes mellitus treated with metformin: glucose and lipid effects. Arch Intern Med. 2008;168:1975–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Walmart Online Pharmacy. Available at http://i.walmartimages.com/1/1f/hmp/fusion/customer_list.pdf accessed February 2011.
  34. 34.
    Online Pharmacy. Available at http://www.drugstore.com. Accessed February 2011.
  35. 35.
    Stone NJ, Blum CB. The lipid lowering drugs. In: Stone NJ, Blum CB, editors. Management of lipids in clinical practice. Caddo: Professional Communications, Inc; 2006. p. 283–354.Google Scholar
  36. 36.
    Mukhtar RYA, Reid J, Reckless JPD. Pitavastatin. Int J Clin Pract. 2005;59(2):239–52.PubMedCrossRefGoogle Scholar
  37. 37.
    Banaszewska B, Pawelczyk L, Spaczynski RZ, et al. Effects of simvastatin and oral contraceptive agent on polycystic ovary syndrome: prospective, randomized, crossover trial. J Clin Endocrinol Metab. 2007;92:456–61.PubMedCrossRefGoogle Scholar
  38. 38.
    Sathyapalan T, Kilpatrick ES, Coady AM, Atkin SL. The effect of atorvastatin in patients with polycystic ovary syndrome: a randomized double blind placebo controlled study. J Clin Endocrinol Metab. 2009;94:103–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366:1267–78.CrossRefGoogle Scholar
  40. 40.
    Hannaford Healthy Saver Plus Online Pharmacy. Available at http://www.hannaford.com/assets/hf/assets/pdf/cms/pharmacy/drug-list-category-2.pdf accessed February, 2011.
  41. 41.
    Kamanna VS, Kashyap ML. Mechanism of action of niacin. Am J Cardiol. 2008;101(8A):20B–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Elam MB, Hunninghake DB, Davis KB, et al. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease. JAMA. 2000;284(10):1263–70PubMedCrossRefGoogle Scholar
  43. 43.
    Taylor AJ, Villnes TC, Stanek EJ, et al. Extended-release niacin or exetimibe and carotid intima media thickness. N Engl J Med. 2009;361:2113–22.PubMedCrossRefGoogle Scholar
  44. 44.
    Schultze AE, Alborn WE, Newton RK, Konrad RJ. Administration of a PPARalpha agonist increases serum apolipoprotein A-V levels and the apolipoprotein A-V/apolipoprotein C-III ratio. J Lipid Res. 2005;46:1591–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Bays HE. Fish oils in the treatment of dyslipidemia and cardiovascular disease. In: Kwiterovich PO, editor. The Johns Hopkins Textbook of Dyslipidemia. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 245–57.Google Scholar
  46. 46.
    Pollack A. Obesity surgery may become an option for many more. The New York Times. December 2010, A1.Google Scholar
  47. 47.
    Eid GM, Cottam DR, Veleu LM, et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1:77–80.PubMedCrossRefGoogle Scholar
  48. 48.
    Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, et al. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2005;90:6364–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Jen HC, Rickard DG, Shew SB, et al. Trends and outcomes of adolescent bariatric surgery in California, 2005–2007. Pediatrics. 2010;126(4):e746–53.PubMedCrossRefGoogle Scholar
  50. 50.
    Consumer Guide to Bariatric Surgery. http://www.yourbariatricsurgeryguide.com/gastric-bypass-cost/ accessed February, 2011.
  51. 51.
    Hoerger TJ, Zhang P, Segal JE, et al. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33(9):1933–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.MEDPACE, Clinical PharmacologyCincinnatiUSA

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