Association between polycystic ovary syndrome and the risk of stroke and all-cause mortality: insights from a meta-analysis

Abstract

Many epidemiologic literatures have investigated the link between PCOS and long-term stroke risk and all-cause mortality, but the results are surprisingly conflicting. A meta-analysis was performed to examine the link between polycystic ovary syndrome (PCOS) and the risk of stroke, death from any cause, and assessed whether BMI might explain a higher risk of stroke. We searched the PUBMED, EMBASE, and Cochrane Library databases with no restrictions. Nine Cohort studies were identified, involving a total of 237,647 subjects. Compared with those without PCOS, subjects with PCOS were significantly associated with a increased risk of developing stroke (OR = 1.36; 95% CI 1.09–1.70; p = .007). However, no significant association was observed between PCOS and all-cause death (OR = 1.21; 95% CI 0.88–1.66; p = .25). Moreover, after pooling the five studies with risk estimates adjusted for BMI, the association between PCOS and stroke was slightly attenuated, although the odds ratios did not reach statistical significance (OR = 1.24; 95% CI 0.98–1.59). In conclusion, PCOS is associated with significant increased risk for stroke, while there is no consistent evidence to indicate that PCOS influences all-cause death outcomes. Increased BMI is an important contributor to the relationship between PCOS and stroke risk. Further study is needed to clarify which subgroups of subjects with the PCOS are at higher risk for stroke and should focus on developing reliable device for risk stratification.

Chinese abstract

许多流行病学文献调查了PCOS与长期卒中风险和全因死亡率之间的关系, 但结果却令人惊讶地相互矛盾。一项荟萃分析研究多囊卵巢综合征（PCOS）与卒中风险、任何原因死亡之间的关系, 并评估BMI是否能解释卒中的高风险。我们没有任何限制地检索了PubMed、EMBASE和Cochrane图书馆的数据库。共确定九项队列研究, 涉及237647名研究对象。与无PCOS患者相比, PCOS患者与发展性卒中风险显著相关(OR =1.36; 95% CI 1.09–1.70; p=.007)。然而, PCOS与全因死亡之间没有显著相关性(OR =1.21; 95% CI 0.88–1.66; p=.25)。此外, 将五项研究与BMI调整后的风险估计相结合后, PCOS与卒中之间的关系略有减弱, 尽管比值比没有达到统计学意义(OR =1.24; 95% CI 0.98–1.59)。总之, PCOS与卒中风险显著增加有关, 但没有一致的证据表明PCOS影响全因死亡结局。BMI增加是PCOS与卒中风险关系的重要因素。需要进一步研究阐明哪些PCOS亚组的中风风险较高, 应侧重于开发可靠的风险分层设备。

Keywords:

• Polycystic ovary syndrome
• Stein–Leventhal syndrome
• cerebrovascular disorders
• stroke
• death
• mortality

Acknowledgments

Yaqiong Zhou MD, Xiaoyun Wang MD, Yongrong Jiang MD, Honglan Ma MD: Conception and design of the study, acquisition and interpretation of data, drafting the article, final approval of the version to be published. Prof. Chaofeng Sun, Li Chen MD, Chenglin Lai MD, Chunrong Pen MD, Caiyun He: Acquisition of data, analysis, and interpretation of data, revising the article, final approval of the version to be published.

Disclosure statement

No potential conflict of interest was reported by the authors.