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      Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome

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          Abstract

          Background

          Polycystic ovary syndrome (PCOS) is associated with obesity and low grade inflammation and the risk for cardiovascular disease (CVD) could be increased in PCOS.

          Methods

          National register-based study including women with PCOS and no previous diagnosis of CVD, hypertension, or dyslipidemia. PCOS Denmark (N = 18,112) included women with PCOS in the Danish National Patient Register. PCOS Odense University Hospital (OUH, N = 1165) was an embedded cohort including premenopausal women with PCOS and clinical and biochemical examination. Three age-matched controls were included per patient in PCOS Denmark (N = 52,769). The main study outcome was CVD events including hypertension and dyslipidemia defined according to nationwide in- and outpatient hospital contact diagnosis codes and/or inferred from filled medicine prescriptions.

          Results

          The age at inclusion was median (quartiles) 29 (23–35) years and follow up was 11.1 (6.9–16.0) years. The Hazard ratio (95% CI) for development of CVD in PCOS Denmark was 1.7 (1.7; 1.8) (P < 0.001) and the total event rate of CVD was 22.6 per 1000 patient years in PCOS Denmark vs. 13.2 per 1000 patient years in controls (P < 0.001). The median age at diagnosis of CVD was 35 (28–42) years in PCOS Denmark vs. 36 (30–43) years in controls (P < 0.001). Obesity, diabetes, and infertility, and previous use of oral contraceptives were associated with increased risk of development of CVD in PCOS Denmark (P < 0.001). Women in PCOS OUH resembled women in PCOS Denmark regarding risk of CVD. Age, BMI, blood pressure, lipid status, and glycemic status predicted development of CVD in PCOS OUH.

          Conclusion

          The event rate of CVD including hypertension and dyslipidemia was higher in PCOS compared to controls. The risk of developing CVD must be considered even in young women with PCOS.

          Electronic supplementary material

          The online version of this article (10.1186/s12933-018-0680-5) contains supplementary material, which is available to authorized users.

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          Most cited references28

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          The polycystic ovary syndrome: a position statement from the European Society of Endocrinology.

          Gerard Conway, Didier Dewailly, Evanthia Diamanti-Kandarakis … (2014)
          Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.
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            Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome

            M Cavaghan, J. Imperial, D A Ehrmann … (1999)
            Article 0 comments Cited 115 times – based on 0 reviews     Review now
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              The potential implications of a PCOS diagnosis on a woman's long-term health using data linkage.

              Roger Hart, Dorota A Doherty (2015)
              The polycystic ovary syndrome (PCOS) is the commonest endocrine abnormality in women of reproductive age.
              Article 0 comments Cited 111 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Dorte Glintborg:
                ORCID: http://orcid.org/0000-0002-8338-8025
                dorte.glintborg@rsyd.dk
                Katrine Hass Rubin: katrine.hass.rubin@rsyd.dk
                Mads Nybo: mads.nybo@rsyd.dk
                Bo Abrahamsen: b.abrahamsen@physician.dk
                Marianne Andersen: msa@rsyd.dk
                Journal
                Journal ID (nlm-ta): Cardiovasc Diabetol
                Journal ID (iso-abbrev): Cardiovasc Diabetol
                Title: Cardiovascular Diabetology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1475-2840
                Publication date (Electronic): 8 March 2018
                Publication date PMC-release: 8 March 2018
                Publication date Collection: 2018
                Volume: 17
                Electronic Location Identifier: 37
                Affiliations
                [1 ]ISNI 0000 0004 0512 5013, GRID grid.7143.1, Department of Endocrinology, , Odense University Hospital, ; Kløvervænget 6, 3rd Floor, 5000 Odense C, Denmark
                [2 ]ISNI 0000 0001 0728 0170, GRID grid.10825.3e, Institute of Clinical Research, , University of Southern Denmark, ; 5000 Odense, Denmark
                [3 ]ISNI 0000 0001 0728 0170, GRID grid.10825.3e, OPEN-Odense Patient Data Explorative Network, Institute of Clinical Research, , University of Southern Denmark, ; 5000 Odense, Denmark
                [4 ]ISNI 0000 0004 0512 5013, GRID grid.7143.1, Department of Clinical Biochemistry and Pharmacology, , Odense University Hospital, ; 4800 Odense, Denmark
                [5 ]ISNI 0000 0004 0646 8763, GRID grid.414289.2, Department of Medicine, , Holbæk Hospital, ; Holbæk, Denmark
                Author information
                http://orcid.org/0000-0002-8338-8025
                Article
                Publisher ID: 680
                DOI: 10.1186/s12933-018-0680-5
                PMC ID: 5844097
                PubMed ID: 29519249
                SO-VID: fd7c5c62-6785-4baa-ada1-a7b5ba162793
                Copyright © © The Author(s) 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 3 January 2018
                Date accepted : 27 February 2018
                Categories
                Subject: Original Investigation
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: polycystic ovary syndrome,register-based,icd-10,ht,cardiovascular disease,medicine prescriptions,nationwide
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: polycystic ovary syndrome, register-based, icd-10, ht, cardiovascular disease, medicine prescriptions, nationwide

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