Cardiovascular health and menopause in aging women with polycystic ovary syndrome

ABSTRACT

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine disorder with heterogeneous clinical manifestations. Current evidence suggests that women with PCOS exhibit an unfavorable metabolic profile which may pose them at increased risk for cardiovascular events later in life.

Areas covered: Herein, we present a review of the existing literature relating to PCOS and long-term cardiovascular (CV) health risks in women after menopause. We performed an electronic-based search with the use of PubMed from 1990 to August 2019 and systematically reviewed studies assessing CV events in women with PCOS. We aimed to outline the gaps in the current evidence and suggest areas for future research.

Expert opinion: Although there is a clear association between PCOS and cardiometabolic dysfunction, data on actual cardiovascular disease (CVD) events are conflicting. Additional large, prospective cohort studies of well-phenotyped women with PCOS and long-term follow-up into the late menopause are needed to elucidate the true CVD risk in this population.

KEYWORDS:

• Polycystic ovary syndrome
• hyperandrogenism
• menopause
• atherosclerosis
• cardiovascular disease

Article highlights

• PCOS is associated with increased prevalence of several cardiometabolic risk factors in women of reproductive age. However, it is still unclear whether the presence of PCOS significantly increases CVD morbidity and mortality later in life.

• The phenotype of PCOS plays an important role in determining the cardiometabolic risk in patients with the syndrome.

• Menopausal transition seems to be not associated with worsening of cardiometabolic profile in PCOS patients. This may be related to the improvement in phenotypic features of PCOS with aging.

• Hyperandrogenemia partly resolves after menopause. However, current data regarding persistent hyperandrogenemia and CVD risk in postmenopausal women with PCOS are inconsistent.

• Long-term studies, particularly community-based prospective cohorts of PCOS with well-defined phenotypes, are needed to clarify the independent role of PCOS on CVD. Ethnic differences should also be considered in these studies.

• There is no established phenotype for PCOS after menopause. Identifying clinical and biochemical characteristics of PCOS in postmenopausal period may provide a reliable estimation of the risk of CV events, until long-term longitudinal studies are conducted.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was not funded.