If You Have PCOS, Are you More Likely to Develop Heart Disease?

With Lubna Pal, MBBS, FACOG

For decades, if you were diagnosed with polycystic ovarian syndrome (PCOS), you were considered to be at increased risk of developing heart disease, too.1-3 Despite the rising rate of cardiovascular disease in women,4 there is reason to believe that this association between PCOS and heart disease may not be as strong as previously thought.5

This should come as good news to the estimated 10-15% of reproductive-age women who have been diagnosed with polycystic ovary syndrome.6

Having PCOS does not impact heart health but type 2 diabetes and obesity can.A woman's risk of heart disease increases with a diagnosis of diabetes or obesity but not because she has PCOS, two experts say.

Why Heart Disease Has Been Labeled a Risk Factor for PCOS?

Elevated cholesterol, high blood pressure, increased insulin levels, and glucose intolerance are common occurrences in women with PCOS, all of which escalate the risk of developing diabetes and heart disease in affected individuals.7 For this reason, doctors and researchers alike have believed women with PCOS are more likely to develop heart problems.5

 “[D]espite having these and other risk factors…there is no credible evidence that there is greater [cardiovascular disease] morbidity in all women with PCOS,” wrote the authors, Enrico Carmina, MD, professor of endocrinology at Palermo University in Argentina, and Rogerio A. Lobo, MD, professor of obstetrics & gynecology at Columbia University Medical Center in New York City. They shared against this commonly held belief but did not respond to several requests for comment.  

While women are more readily diagnosed as having PCOS based on reproductive abnormalities, there are equally compelling endocrine- and metabolic-related disruptions related to this complex condition,7 leading these reproductive endocrinologists to take a closer look at the presumed relationship between PCOS and heart disease.5

Dr. Carmina and Dr. Lobo identified and reviewed published studies involving women who were diagnosed with PCOS to see if there was a notable pattern or association with heart problems.5

Simply put, they found no apparent connection, meaning women with polycystic ovary syndrome have no greater risk of developing cardiovascular disease than women who do not have PCOS.5 “These data have led us to challenge the notion of increased [cardiovascular] events in all women with PCOS,” the authors report

However, according to these experts, most of the available studies were poorly designed.5 For example, the studies were inconsistent in how women were diagnosed as having PCOS. Sometimes, women were labeled as having PCOS simply because they indicated having irregular periods, and other times, other symptoms were used in making the diagnosis.

In addition, many of the women followed in the selected studies had conditions, such as diabetes or obesity, which have a direct relationship with increased risk of heart disease, even in the absence of PCOS,5 making the ability to detect any pattern with PCOS alone much more difficult.

Obesity and Diabetes Present Direct Concern for Heart Health

Type 2 diabetes and obesity are commonly experienced in women with PCOS, and both conditions increase the lifetime risk of developing heart disease.5   

Two well-designed retrospective studies suggested cause for concern. One study showed an increase in heart-related mortality amongst women with PCOS who also had diabetes.8 The other study showed an increase in cardiovascular events, including heart attacks.9

“…[L]ifestyle management, which should be a key feature of care of all women with PCOS, is particularly important to prevent obesity and diabetes. Early identification of glucose intolerance in women with PCOS is of paramount importance,”5 the authors write.

A related article you might like: PCOS Diet

We approached Lubna Pal, MBBS, FACOG, professor of obstetrics, gynecology, and reproductive sciences and director of the Polycystic Ovary Syndrome Program at Yale School of Medicine in New Haven, Connecticut,  for her expert opinion on this topic.

“The challenge here is that we have such little longitudinal [long-term] data in terms of cardiovascular outcomes that for us to say there is harm or there is protection is just hypothesis generation at this point,” she tells EndocrineWeb, meaning there isn’t enough evidence for a clear answer.

Another obstacle that arises in studying PCOS, Dr. Pal says, is that there is no one agreed upon definition for what constitutes polycystic ovary syndrome in clinical trials, nor is this syndrome a standard set of symptoms or simple to diagnose. 

“It’s like a fruit basket—The PCOS diagnostic criteria are so varied that it’s like having to choose from apples, oranges, strawberries, grapes, and plums all in one basket. When we want to know how quickly the fruit might deteriorate, there’s no easy answer because each of the different entities has an influence in the freshness of the basket, Dr. Pal says, so we need to separate out the fruit into like groups to tease out a valid answer.”  

It is In the Patient’s Best Interest to Take Control of Her Health

You may wonder in light of all of this information, what your individual concerns regarding heart disease should be? Dr. Pal provided her insights on what she would like patients to know. 

Certainly, women who have PCOS, as well as T2D or obesity, might be recognized as having greater cause for concern about their heart health due to these related conditions but no greater risk as a resulting of the polycystic ovary syndrome.       

“We can approach concerns about heart disease by focusing on optimizing [overall] wellness rather than worrying about being unwell,” she says.  In women with PCOS, the goal is not to try to prevent cardiovascular disease; rather, we are trying to help you achieve the best heart health.

To do this, Dr. Pal advises all of her patients to take action and make the necessary adjustments when they learn they may have an increased risk for heart disease. These risks include: high blood cholesterol as well as high triglycerides, elevated high density lipoprotein (LDL) levels or low high density lipoprotein (HDL), or high blood pressure.  

When my patients—the younger the better— respond to our suggestions by making the necessary lifestyle changes particularly as it concerns diet and physical activity, they see the benefits as their risk for heart disease decreases.

“Nothing drastic is happening while you are still young, but there is room for you to improve based on all this data collected in other populations,” she said. "What we can say clearly is that young women who present with an at-risk profile at a young age should be reassured that these potentially concerning conditions can be abated.

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