Cardiovascular events among reproductive and menopausal age women with polycystic ovary syndrome: a systematic review and meta-analysis

Abstract

This study aimed to evaluate the prevalence (P)/hazard ratio (HR) of cardiovascular (CV) events among reproductive age and menopausal age women with polycystic ovary syndrome (PCOS) in comparison with healthy controls. PubMed, Scopus, ScienceDirect, Web of science, and Google scholar were searched for retrieving observational studies published up to April 2018 investigating CV events in patients with PCOS. The primary outcomes were a composite outcome of CV events [including coronary arterial disease (CAD), cardiovascular disease (CVD), myocardial infarction (MI), angina, heart failure, and ischemic heart disease] and mortality due to CV events; secondary outcomes were specific CVD events, including cerebrovascular disease, CAD, CVD, MI, angina, heart failure, ischemic heart disease, and stroke. In this meta-analysis, both fixed and random effect models were used. Potential sources of heterogeneity were explored by meta-regression and subgroup analyses. Sixteen studies including 12 population-based were analyzed for the meta-analysis. Results showed that the pooled HRs of CV events in PCOS patients of reproductive age and in menopausal/aging women were higher than healthy controls (pooled HR: 1.38, 95% CI: 1.12–1.71) and (pooled HR: 1.53, 95% CI: 1.15, 2.04), respectively. Compared to healthy controls, analysis of population-based studies revealed that the HR of CV events increased only in reproductive age PCOS patients (1.43-fold, 95% CI: 1.27, 1.61), whereas the difference was not statistically significant when comparing menopausal/aging PCOS patients to healthy controls (1.03-fold, 95% CI: 0.41, 2.59). Sufficient data were not available for comparing the HRs of mortality due to CV events between the two PCOS age groups. Mainly based on population-based study, we found a greater risk of CV events in reproductive aged but not in menopausal/aging PCOS women, suggesting that having a history of PCOS during reproductive ages may not be an important risk factor for developing events in later life. This is a preliminary assumption and needs to be reevaluated by further comprehensive cohort studies of longer duration, initiated in the reproductive period, considering all known CVD risk factors.

摘要

本研究旨在评估育龄期和绝经年龄多囊卵巢综合征患者中的心血管（CV）事件的患病率（P）/风险比（HR）并与健康对照进行比较。在PubMed, Scopus, ScienceDirect, Web of science和Google scholar中检索2018年4月之前发表的调查PCOS患者CV事件的观察性研究。主要结局是复合终点：CV事件【包括冠状动脉疾病（CAD）, 心血管疾病（CVD）, 心肌梗死（MI）, 心绞痛, 心衰和缺血性心脏病】和由于CV事件导致的死亡；次要结局是特定的CVD事件, 包括心脑血管疾病, CAD, CVD, MI, 心绞痛, 心衰, 缺血性心脏病和中风。在本篇meta分析中, 采用了固定效应模型和随机效应模型。采用meta-回归和亚组分析分析异质性的可能来源。meta分析共纳入16篇研究, 其中包括12篇以人群为基础的研究。结果显示：育龄期和绝经年龄女性PCOS患者的合并HRS（合并 HR: 1.53, 95% CI: 1.15, 2.04）高于健康对照（合并 HR: 1.38, 95% CI 1.12-1.71）。与健康对照相比, 以人群为基础的分析显示CV事件的HR增加只在生育期PCOS患者（1.43倍, 95% CI: 1.27, 1.61）,当绝经年龄PCOS患者与健康对照相比时, 差异无统计学意义（1.03倍, 95% CI：0.41, 2.59）。没有足够的数据对两个PCOS年龄组中由CV事件导致的死亡率的HRs进行比较。主要基于以人群为基础的研究中, 我们发现, CV事件的风险在育龄期中增高, 在绝经年龄PCOS女性中未增高, 表明育龄期有PCOS病史可能不是以后发生心血管事件的重要危险因素。这是一个初步的假设, 需要在考虑所有已知的心血管疾病风险因素的情况下, 通过在生育期开始的更全面的队列研究来重新评估。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Cardiovascular disease
• meta-analysis
• polycystic ovary syndrome (PCOS)
• hazard ratio

Acknowledgements

The authors wish to acknowledge Ms Niloofar Shiva for critical editing of English grammar and syntax of the manuscript.

Authors' contributions

F.R.T was involved in study design, quality assessment, data analysis, manuscript drafting, revising manuscript, and critical discussion. M.A was involved in study design, search in databases, quality assessment, study selection, data extraction, data analysis, manuscript drafting, and critical discussion. S.B.G contributes in quality assessment, data extraction, manuscript drafting and critical discussion. R.B.Y contributed in statistical analysis, interpreting data, and manuscript drafting. E.C was involved made substantial contributions to conception and design, search in databases, data analysis, the manuscript revision, and critical discussion. All authors have read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Research reported in this publication was supported by Elite Researcher Grant Committee under award number [971169] from the National Institutes for Medical Research Development (NIMAD), Tehran, Iran.