Escolar Documentos
Profissional Documentos
Cultura Documentos
*Third report of the National Cholesterol Education Program. Expert panel on the detection,
evaluation and treatment of high blood cholesterol in adults. Final report. Circulation 106,
3143-3421 (2002).
Insulin Resistance
• Insulin resistance is commonly, though not
universally, found in PCOS, with
prevalence being estimated in 50-70% of
cases.(*)
*Dunaif A. Insulin resistance and polycystic ovary syndrome: mechanisms and implications for
atherogenesis. Endocr. Rev. 18, 774-800 (1997).
Lipid Profiles and PCOS
• Almost 70% of patients with PCOS have
an abnormal lipid profile and high
triglycerides and low high-density
lipoprotein (HDL) cholesterol are often
found. *
*Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with
polycystic ovary syndrome. Am. J. Med. 111, 607-613 (2001).
Long Term Risks
Associated with PCOS
Source of Image: Teede, Helena j. et al., Assessment and management of polycystic ovary syndrome: summary
of an evidence-based guideline, Med J Aust 2011; 195 (6): S69.
“Risk of Coronary Artery Disease in Mothers of Women with PCOS”
Kai I Cheang, John E Nestler and Walter Futterweit
The Endocrine Society's 89th Annual Meeting
Abstract presented in Toronto June 4th 2007
• 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.
Polycystic Ovary Syndrome and Cardiovascular Disease: Premature
Association?
Richard S. Legro
Endocrine Reviews June 1, 2003; 24 (3): 302-312
• Women with polycystic ovary syndrome (PCOS) are often assumed, a priori, to be at increased
risk for cardiovascular disease (CVD), given the high prevalence of the metabolic syndrome X
among them.
• There is, however, no single definition of PCOS, and for that reason a comparison of studies that
have analyzed its association with CVD is compromised from the start.
• Long-term studies of well characterized women with PCOS are lacking, and the link to primary
cardiovascular events such as stroke or myocardial infarction remains more speculative than
substantive.
• Epidemiological studies that have focused on isolated signs and stigmata of PCOS, such as
polycystic ovaries, hyperandrogenism, or chronic anovulation, have found mixed results.
• There are studies that suggest a slight increase in cardiovascular events in women with polycystic
ovaries, with perhaps stronger evidence between an increased risk of cardiovascular events in
women with menstrual irregularity.
• However, there is little evidence for an association between hyperandrogenism per se and
cardiovascular events.
• Furthermore, there are less data to substantiate an increased risk of events in women with PCOS
identified on the basis of a combination of signs and symptoms, such as hyperandrogenic chronic
anovulation.
• The existing data suggest that PCOS may adversely affect or accelerate the development
of an adverse cardiovascular risk profile, and even of subclinical signs of atherosclerosis,
but it does not appear to lower the age of clinical presentation to a premenopausal age
group.
• Future studies to identify the risk of cardiovascular events in women with PCOS will benefit from
clear and extensive phenotyping of PCOS abnormalities at baseline, from a prospective design,
from larger sample sizes, and from longer follow-up.
Cardiovascular Risk in PCOS
• Several studies using intima media
thickness as a surrogate for
cardiovascular risk evaluation have
shown potential increased
cardiovascular risk in women with
PCOS.*
* Talbot EO, Guzick DS, Sutton-Tyrrell K et al. Evidence for association between polycystic ovary syndrome
and premature carotid atherosclerosis in middle-aged women. Arterioscler. Thromb. Vasc. Biol. 20, 2414-
2421 (2000).
* Vryonidou A, Papatheodorou A, Tauridou A et al. Association of hyperandrogenism and metabolic
phenotype with carotid intima-media thickness in young women with polycystic ovary syndrome. J. Clin.
Endocrinol. Metab. 90, 2740-2746 (2005).
* Luque-Ramirez M, Mendieta-Azcona C, Alvarez-Blasco F, Escobar-Morreale HF. Androgen excess is
associated with increased carotid intima-media thickness observed in young women with polycystic
ovary syndrome. Hum. Reprod. 22, 3197-3203 (2007).
Coronary Artery Calcification
and PCOS
• A similar study using coronary artery
calcification as risk stratification has
shown increased risk in patients with
PCOS.*
* Christian R, Dumesic DA, Behrenbeck T, Oberg AL, Sheedy PF, Fitzparick LA. Prevalence and
predictors of coronary artery calcification in women with polycystic ovary syndrome. J.
Clin. Endocrinol. Metab. 88, 2562-2568 (2003).
Sleep Apnea and Other Sleep
Disorders
• Multiple groups have documented an increased
risk for sleep apnea and other sleep disorders
including increased daytime somnolence, such
as sleep disordered breathing in women with
PCOS.
• This is surprising as sleep apnea is relatively
uncommon in women, especially
premenopausal women.
Body Image and Quality of Life in
PCOS Patients
• There is little study of the
psychopathology of women defined as
having PCOS in literature
• PCOS disease-specific questionnaire
known as the PCOSQ has been
developed to study the above questions.
• Obesity and infertility cause the greatest
degree of stress
Body Image and Quality of Life in
PCOS Patients
• Both anorexia nervosa and bulimia
have been linked with PCOS(etiological
link?)
• Many conditions co-exist with PCOS such
as pelvic pain, depression and altered
mood but it is unclear where there is a
casual or causal association.
Pregnancy in PCOS
• Increased risk of Pregnancy-related
Hypertension
• Increased risk of Pregnancy-related
Diabetes
• Increased risk for Miscarriages
Morphology of the Polycystic
Ovary
• Ovary with 12 or more follicles*
measuring 2-9 mm in diameter and/or
• Increased ovarian volume(>10 cubic
centimeters)