Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorde r characterized by obesity, hyperandrogenism, and insulin resistance. An ad verse lipid profile has also been observed in PCOS-affected women, suggesti ng that these individuals may be at increased risk for coronary heart disea se at a young age. The objective of the present study was to evaluate subcl inical atherosclerosis among women with PCOS and age-matched control subjec ts. A total of 125 white PCOS cases and 142 controls, aged greater than or equal to 30 years were recruited. Collection of baseline sociodemographic d ata, reproductive hormone levels, and cardiovascular risk factors was condu cted from 1992 to 1994. During follow-up (1996 to 1999), these women underw ent B-mode ultrasonography of the carotid arteries for the evaluation of ca rotid:intima-media wall thickness (IMT) and the prevalence of plaque. A sig nificant difference was observed in the distribution of carotid plaque amon g PCOS cases compared with controls: 7.2% (9 of 125) of PCOS cases had a pl aque index of greater than or equal to3 compared with 0.7% (1 of 142) of si milarly aged controls (P = 0.05). Overall and in the group aged 30 to 44 ye ars, no difference was noted in mean carotid IMT between PCOS cases and con trols. Among women aged greater than or equal to 45 years, PCOS cases had s ignificantly greater mean IMT than did control women (0.78 +/- 0.03 versus 0.70 +/- 0.01 mm, P = 0.005). This difference remained significant after ad justment for age and BMI (P < 0.05). These results suggest that (I) lifelon g: exposure to an adverse cardiovascular risk profile in women with PCOS ma y lead to premature atherosclerosis, and (2) the PCOS-IMT association is ex plained in part by weight and fat distribution and associated risk factors. There may be an independent effect of PCOS unexplained by the above variab les that is related to the hormonal dysregulation of this condition.