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Division of Endocrinology, Metabolism, Diabetes, and Nutrition, Department of Internal Medicine; Department of Obstetrics and Gynecology (D.A.D.); Division of Cardiovascular Diseases, Department of Internal Medicine (T.B.); Department of Health Sciences Research (A.L.O.); and Department of Radiology (P.F.S.), Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905
Address all correspondence and requests for reprints to: Lorraine A. Fitzpatrick, M.D., Division of Endocrinology, Metabolism, Diabetes, and Nutrition, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905. E-mail: fitz{at}mayo.edu.
Polycystic ovary syndrome (PCOS), a common endocrine disorder of reproductive-aged women, is associated with multiple risk factors for coronary heart disease (CHD), such as diabetes mellitus, dyslipidemia, visceral obesity, and hypertension. However, premature coronary atherosclerosis has not been demonstrated in PCOS women. Electron beam computed tomography (EBCT) noninvasively measures coronary artery calcium (CAC), a marker for coronary atherosclerosis. We measured CAC by EBCT in 30- to 45-yr-old premenopausal PCOS women and compared the results to CAC in 1) recruited normal ovulatory volunteers matched for age and weight to the PCOS cohort, and 2) community-dwelling women of similar age in an extant coronary calcium database. Healthy, community-dwelling, ovulatory controls (n = 71) were matched by age and body mass index (BMI) to PCOS women (n = 36). Women with diabetes or known CHD were excluded. Subjects underwent EBCT scanning, oral glucose tolerance testing, and CHD risk factor assessment.
PCOS women had significantly higher levels of serum total and low density lipoprotein cholesterol and testosterone levels than matched controls. PCOS and control women were obese and had a greater mean BMI than community-dwelling women (33 kg/m2 for PCOS vs. 31 kg/m2 for control; P < 0.001). CAC was more prevalent in PCOS women (39%) than in matched controls (21%; odds ratio, 2.4; P = 0.05) or community-dwelling women (9.9%; odds ratio, 5.9; P < 0.001). BMI, waist circumference, and total and low density lipoprotein cholesterol levels predicted CAC prevalence after adjustment for BMI.
CAC is more prevalent in PCOS women than in obese or nonobese women of similar age. PCOS women are at increased risk for atherosclerosis and should be targeted for primary prevention of CHD.
Data from the ECAC study was supported in part by NIH Grant R01-HL-46292. Salary support for R.C. was from NIH NHLB Training Grant (5-T32-07111) and the Mayo Clinic Women’s Health Fellowship, supported by an unrestricted educational grant from Solvay Pharmaceuticals, Inc. This work was supported in part by a General Clinical Research Center grant from the NIH (MO1-RR-00585), NIH HLBI Research Grant R01-HL-51736-7, NIH NCRR Grant K24-RR-17593, and research funding from the Mayo Foundation.
Abbreviations: BMI, Body mass index; CAC, coronary artery calcium; CHD, coronary heart disease; CI, confidence interval; CV, coefficient(s) of variation; EBCT, electron beam computed tomography; ECAC, Epidemiology of Coronary Artery Calcification; F-G, Ferriman-Gallwey; HDL, high density lipoprotein; IGT, impaired glucose tolerance; LDL, low density lipoprotein; Ln, natural log; OR, odds ratio; PCOS, polycystic ovary syndrome.
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