The Cardiometabolic Risk in Women with Polycystic Ovarian Syndrome (PCOS): From Pathophysiology to Diagnosis and Treatment

Overview

Journal Medicina (Kaunas)

Publisher MDPI

Specialty General Medicine

Date 2024 Oct 26

PMID 39459443

Authors

Sotirios Pililis

Stamatios Lampsas

Aikaterini Kountouri

Loukia Pliouta

Emmanouil Korakas

Sarantis Livadas

John Thymis

Melpomeni Peppa

Sophia Kalantaridou

Evangelos Oikonomou

Ignatios Ikonomidis

Vaia Lambadiari

Affiliations

Soon will be listed here.

Abstract

Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, with significant variations in presentation characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Beyond reproductive health, it may also pose crucial long-term cardiometabolic risks, especially for women with specific types of PCOS, contributing to early subclinical cardiovascular atherosclerotic alterations such as endothelial dysfunction, increased arterial stiffness, and coronary artery calcium levels, respectively. Moreover, the precise relationship between clinical cardiovascular disease (CVD) and PCOS remains debated, with studies demonstrating an elevated risk while others report no significant association. This review investigates the pathophysiology of PCOS, focusing on insulin resistance and its link to subclinical and clinical cardiovascular disease. Diagnostic challenges and novel management strategies, including lifestyle interventions, medications like metformin and glucagon-like peptide-1 receptor agonists (GLP-1RAs), hormonal contraceptives, and bariatric surgery, are further discussed. Recognizing the cardiometabolic risks associated with PCOS, a comprehensive approach and early intervention should address both the reproductive and cardiometabolic dimensions of the syndrome.

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References

Pehlivanov B, Mitkov M . Serum leptin levels correlate with clinical and biochemical indices of insulin resistance in women with polycystic ovary syndrome. Eur J Contracept Reprod Health Care. 2009; 14(2):153-9. DOI: 10.1080/13625180802549962. View

Salilew-Wondim D, Wang Q, Tesfaye D, Schellander K, Hoelker M, Hossain M . Polycystic ovarian syndrome is accompanied by repression of gene signatures associated with biosynthesis and metabolism of steroids, cholesterol and lipids. J Ovarian Res. 2015; 8:24. PMC: 4414284. DOI: 10.1186/s13048-015-0151-5. View

Bhandari M, Kosta S, Bhandari M, Reddy M, Mathur W, Gupta M . Effects of Bariatric Surgery on People with Obesity and Polycystic Ovary Syndrome: a Large Single Center Study from India. Obes Surg. 2022; 32(10):3305-3312. DOI: 10.1007/s11695-022-06209-3. View

Nylander M, Frossing S, Clausen H, Kistorp C, Faber J, Skouby S . Effects of liraglutide on ovarian dysfunction in polycystic ovary syndrome: a randomized clinical trial. Reprod Biomed Online. 2017; 35(1):121-127. DOI: 10.1016/j.rbmo.2017.03.023. View

Sadeghi H, Adeli I, Calina D, Docea A, Mousavi T, Daniali M . Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. Int J Mol Sci. 2022; 23(2). PMC: 8775814. DOI: 10.3390/ijms23020583. View

Thijssen D, Bruno R, van Mil A, Holder S, Faita F, Greyling A . Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. Eur Heart J. 2019; 40(30):2534-2547. DOI: 10.1093/eurheartj/ehz350. View

Tay C, Mousa A, Vyas A, Pattuwage L, Ramezani Tehrani F, Teede H . 2023 International Evidence-Based Polycystic Ovary Syndrome Guideline Update: Insights From a Systematic Review and Meta-Analysis on Elevated Clinical Cardiovascular Disease in Polycystic Ovary Syndrome. J Am Heart Assoc. 2024; 13(16):e033572. DOI: 10.1161/JAHA.123.033572. View

. ACOG Practice Bulletin No 156: Obesity in Pregnancy. Obstet Gynecol. 2015; 126(6):e112-e126. DOI: 10.1097/AOG.0000000000001211. View

Oikonomou E, Souvaliotis N, Lampsas S, Siasos G, Poulakou G, Theofilis P . Endothelial dysfunction in acute and long standing COVID-19: A prospective cohort study. Vascul Pharmacol. 2022; 144:106975. PMC: 8893931. DOI: 10.1016/j.vph.2022.106975. View

10.

Kaminska W, Wisniewska K, Okreglicka K, Pazura I, Nitsch-Osuch A . Lifestyle intervention towards Mediterranean Diet, physical activity adherence and anthropometric parameters in normal weight women with Polycystic Ovary Syndrome or Hashimoto's Thyroiditis - preliminary study. Ann Agric Environ Med. 2023; 30(1):111-117. DOI: 10.26444/aaem/159156. View

11.

Sam S, Dunaif A . Polycystic ovary syndrome: syndrome XX?. Trends Endocrinol Metab. 2003; 14(8):365-70. DOI: 10.1016/j.tem.2003.08.002. View

12.

Ding D, Tsai I, Wang J, Lin S, Sung F . Coronary artery disease risk in young women with polycystic ovary syndrome. Oncotarget. 2018; 9(9):8756-8764. PMC: 5823557. DOI: 10.18632/oncotarget.23985. View

13.

Eisenberg D, Shikora S, Aarts E, Aminian A, Angrisani L, Cohen R . 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022; 18(12):1345-1356. DOI: 10.1016/j.soard.2022.08.013. View

14.

Gulanski B, Flannery C, Peter P, Leone C, Stachenfeld N . Compromised endothelial function in transgender men taking testosterone. Clin Endocrinol (Oxf). 2019; 92(2):138-144. PMC: 6957681. DOI: 10.1111/cen.14132. View

15.

Dabravolski S, Nikiforov N, Eid A, Nedosugova L, Starodubova A, Popkova T . Mitochondrial Dysfunction and Chronic Inflammation in Polycystic Ovary Syndrome. Int J Mol Sci. 2021; 22(8). PMC: 8070512. DOI: 10.3390/ijms22083923. View

16.

Liu Y, Qin Y, Wu B, Peng H, Li M, Luo H . DNA methylation in polycystic ovary syndrome: Emerging evidence and challenges. Reprod Toxicol. 2022; 111:11-19. DOI: 10.1016/j.reprotox.2022.04.010. View

17.

Ibanez L, Oberfield S, Witchel S, Auchus R, Chang R, Codner E . An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Horm Res Paediatr. 2017; 88(6):371-395. DOI: 10.1159/000479371. View

18.

Oikonomou E, Theofilis P, Lampsas S, Katsarou O, Kalogeras K, Marinos G . Current Concepts and Future Applications of Non-Invasive Functional and Anatomical Evaluation of Coronary Artery Disease. Life (Basel). 2022; 12(11). PMC: 9696378. DOI: 10.3390/life12111803. View

19.

Xiang Y, Wang H, Ding H, Xu T, Liu X, Huang Z . Hyperandrogenism drives ovarian inflammation and pyroptosis: A possible pathogenesis of PCOS follicular dysplasia. Int Immunopharmacol. 2023; 125(Pt A):111141. DOI: 10.1016/j.intimp.2023.111141. View

20.

Aksun S, Sonu N, Aygun S, Karakulak U, Mumusoglu S, Yildiz B . Alterations of cardiometabolic risk profile in polycystic ovary syndrome: 13 years follow-up in an unselected population. J Endocrinol Invest. 2023; 47(5):1129-1137. DOI: 10.1007/s40618-023-02230-0. View