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Young Obese Women with Polycystic Ovary Syndrome Have Evidence of Early Coronary Atherosclerosis

Departments of Obstetrics and Gynecology (R.S., A.K., M.M., A.D.), Radiology (E.J.R.V.B.), and Internal Medicine (D.J.), University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa 52242

Address all correspondence and requests for reprints to: Anuja Dokras, M.D., Ph.D., Department of Obstetrics and Gynecology, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242. E-mail: ADokras{at}obgyn.upenn.edu.

Context: Polycystic ovary syndrome (PCOS) is associated with comorbidities that may contribute to increased risk of cardiovascular disease. PCOS is associated with increased risk of metabolic syndrome, dyslipidemia, and diabetes, but it remains unclear whether traditional cardiovascular (CV) risk factors can help predict coronary artery disease in this population.

Objective: The objectives of the study were to detect early-onset subclinical coronary atherosclerosis (using coronary artery calcium as a marker) in young women with PCOS, compared with age- and body mass index-matched controls, and to compare traditional CV risk factors and inflammatory markers in the two groups.

Design: This was a prospective case-control study.

Setting: The study was conducted at a university hospital.

Subjects: Twenty-four obese (body mass index 30 kg/m²) PCOS subjects and 24 obese controls participated.

Outcome Measures: Coronary artery calcium, inflammatory markers (high-sensitivity C-reactive protein, IL-6, TNF, adiponectin, leptin), fasting blood tests (glucose, lipids, insulin), and dual-energy x-ray absorptiometry scan for body fat distribution were measured.

Results: Coronary artery calcium was detected in eight of 24 PCOS subjects (33%) and two of 24 controls (8%) (odds ratio 5.5, 95% confidence interval 1.03, 29.45, P < 0.03). Traditional CV risk factors did not differ significantly between the two groups, nor did markers of inflammation or adiposity, body fat distribution, or metabolic parameters with the exception of significantly lower quantitative insulin sensitivity check index (marker for insulin resistance) in the PCOS group (P < 0.05).

Conclusions: Young, obese women with PCOS have a high prevalence of early asymptomatic coronary atherosclerosis, compared with obese controls. This increased risk is independent of traditional CV risk factors and novel markers of inflammation. These findings underscore the need to screen and aggressively counsel and treat these women to prevent symptomatic CV disease.

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