PCOS Tied to Risk for Cardiovascular Disease After Menopause

Women with polycystic ovarian syndrome (PCOS) before menopause appear to have a greater risk of stroke, heart attack, and other cardiovascular events after menopause, according to findings presented Saturday, October 17, at the virtual American Society for Reproductive Medicine (ASRM) 2020 Scientific Congress.

"We found a PCOS diagnosis prior to menopause was associated with a 64% increased risk of cardiovascular disease after menopause independent of age at enrollment, race, body mass index, and smoking status," presenter Jacob Christ, MD, a resident at the University of Washington in Seattle, told attendees. "Taken together, our results suggest that women with PCOS have more risk factors for future cardiovascular disease at baseline, and a present PCOS diagnosis prior to menopause is associated with an increased risk of cardiovascular disease after menopause."

Dr Jacob Christ

The results are important to consider in women seeking care related to fertility, according to Amanda N. Kallen, MD, an assistant professor of reproductive endocrinology and infertility at Yale Medicine in New Haven, Connecticut.

"As fertility specialists, we often see women with PCOS visit us when they are having trouble conceiving, but often [they] do not return to our care once they've built their family," said Kallen, who was not involved in the research.

"This excellent talk emphasized how critical it is for us as reproductive endocrinologists to have ongoing discussions with PCOS patients about long-term cardiovascular risks at every opportunity, and to emphasize that these risks persist long after the reproductive years have ended," Kallen told Medscape Medical News.

Identifying Women at Higher Risk

Characteristics of PCOS in adolescence are already understood, including hyperandrogenism, acne, irregular bleeding, and variable ages of menarche, Christ explained. Similarly, in women's reproductive years, PCOS is linked to abnormal uterine bleeding, hirsutism, dyslipidemia, infertility, impaired glucose tolerance, gestational diabetes, and preeclampsia.

"What is less clear is if baseline cardiometabolic dysfunction during reproductive years translates into cardiovascular disease after menopause," Christ said. "Menopausal changes may reduce risk of cardiovascular disease among PCOS women, as it is known that overall, androgen levels decline during menopause. Furthermore, ovarian aging may be delayed in PCOS women, which may be protective against cardiovascular disease."

To learn more, the researchers completed a secondary analysis of data from the Study of Women's Health Across the Nation (SWAN), a prospective cohort study. Women enrolled in the study were aged 42 to 52 years at baseline, had a uterus and at least one ovary, and menstruated within the previous 3 months. Women were considered to have PCOS if they had both biochemical hyperandrogenism and a history of irregular menses.