PCOS Alone Does Not Increase Your Risk of Heart Disease

With Lubna Pal, MBBS, FACOG

PCOS is not a risk factor for heart disease.PCOS is no longer considered a risk factor for heart disease.

For decades, if you were diagnosed with polycystic ovarian syndrome (PCOS), you were told that you had increased risk of developing heart disease. Despite the rising rate of cardiovascular disease in women, there is reason to believe that this association between PCOS and heart disease is not as strong as previously thought.

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

Why has PCOS been labeled as a risk factor for heart disease in the past?

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. For this reason, doctors and researchers alike have believed women with PCOS are more likely to develop heart problems.

"Despite these other risk factors, there is no credible evidence that there is greater cardiovascular disease morbidity in all women with PCOS,” wrote the authors of a recent study, 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. 

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

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.

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. “These data have led us to challenge the notion of increased cardiovascular events in all women with PCOS,” the authors report

According to these experts, most of the available studies were poorly designed. 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 other conditions, such as diabetes or obesity, which have a direct relationship with increased risk of heart disease, even in the absence of PCOS, making the ability to detect any pattern with PCOS alone difficult.

Obesity and diabetes present the direct concern for heart health in women who also have PCOS

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

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 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 says, 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. 

You may wonder in light of all of this information, what your individual concerns regarding heart disease should be if you have been diagnosed with PCOS? 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 there is no greater risk as a resulting of polycystic ovary syndrome alone.    

Dr. Pal advises all of her patients to take action and make the necessary adjustments when they learn they have other indicators of an increased risk for heart disease. These well-documented 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, but not PCOS.

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