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Risk of Coronary Artery Disease in Mothers of Women with PCOS

Kai I Cheang¹, John E Nestler² and Walter Futterweit³

¹Department of Pharmacy, Virginia Commonwealth University, Richmond, VA, United States, 23298-0111;
²Department of Internal Medicine, Division of  Endocrinology and Metabolism, Virginia Commonwealth University, Richmond, VA, United States, 232980111
³Department of Medicine, Division of Endocrinology, Mt. Sinai Medical Center, New York, NY, United States, 10128.

The Endocrine Society's 89th Annual Meeting
Abstract presented in Toronto June 4th 2007


Background:
Women with PCOS have a higher prevalence of cardiovascular disease (CAD) risk factors (e.g. dyslipidemia, hypertension and diabetes), and subclinical CAD (coronary calcification and carotid intimamedia thickness), as compared with normal women. However, whether women with PCOS are at a higher risk of clinical CAD events is debated. While several studies reported higher risks of CAD and fatal myocardial infarction (MI) in women with PCOS (1-3), death certificates of PCOS women in UK did not show increased CAD mortality compared with the expected rate from actuarial tables (4). The purpose of this study was to assess the prevalence of CAD in postmenopausal PCOS women. To capture such a population, the presence of CAD in PCOS and non-PCOS mothers of women with PCOS was determined.

Method:
In a single endocrine clinic, 270 women with PCOS were surveyed about their mothers’ medical history. The survey covered menstrual history, fertility, clinical signs of hyperandrogenism (i.e. hirsutism, alopecia, acne), onset of CAD risk factors (e.g. hypertension, dyslipidemia, diabetes), age of incident CAD, fatal and non-fatal MI, and age of death. About 60% of the daughters’ initial history was verified by personal interviews with the mothers. Presence of PCOS in the mothers was defined as relative difficulty in achieving pregnancy, presence of irregular menses, and clinical signs of hyperandrogenism. Presence of CAD was defined as any percutaneous coronary intervention, angina that necessitated emergency room visits, or fatal or nonfatal MI.

Results:
Among the 270 women with PCOS, 60 had mothers with probable PCOS while 210 mothers did not meet the PCOS criteria. Complete cardiovascular history was successfully obtained from 39 PCOS mothers and 75 normal mothers. The mean age of PCOS mothers at the time of survey did not differ from that of non-PCOS mothers (58.6 + 1.3 vs. 58.6 + 0.7, respectively). Including only those mothers whose cardiovascular histories were available, 13 of 39 (33.3%) PCOS mothers had CAD compared with 1 of 75 (1.3%) normal mothers (p<0.0001). Eight of 39 (20.5%) PCOS mothers had suffered an MI compared with 1 of 75 (1.3%) normal mothers (p<0.0001). Notably, all PCOS mothers who had an MI were 65 years old or younger at the time of their incident MI.

Conclusion:
PCOS mothers of women with PCOS are at a higher risk of CAD events compared with non-PCOS mothers, and MI appears to occur at an earlier than expected age in PCOS mothers.

References:
(1) Elting MW et al., Hum Reprod 2001; 16:556
(2) Birdsall MA et al., Ann Intern Med 1997; 126:32
(3) Solomon CG et al., J Clin Endocrinol Metab 2002; 87:2013
(4) Pierpoint T et al., J Clin Epidemiol 1998; 51:581
Sources of Support: NIH K23HD049454 awarded to KIC
Author: Kai I Cheang