Description

Polycystic Ovarian Syndrome (PCOS) is a common
endocrinopathy affecting approximately 6.6% of adult
women. It is traditionally characterised by the presence of
polycystic ovaries on ultrasound, along with hirsutism, acne
and subfertility. The presence of multiple elevated
cardiovascular risk factors such as dyslipidaemia,
hypertension, obesity, non-gynoid fat distribution and
insulin resistance is now beginning to be recognised. Whilst
there may be an increased prevalence of diabetes mellitus in
PCOS patients, the existence of other related morbidity and
mortality remains controversial. Existing studies are
insufficient to fully assess the presence of cardiovascular
morbidity/mortality in PCOS patients. The current limited
prospective data does support an increased prevalence of
cardiovascular disease.

This article explores some of the mechanisms which
may contribute to cardiometabolic disease in PCOS
patients. The literature suggests PCOS patients are affected
by endothelial dysfunction and studies lend support for a role
of hyperandrogenism in this. Endothelial dysfunction may
contribute to clotting disorders and evidence implies an
altered fibrinolytic pathway. The incidence and extent of
atherosclerosis is also higher in PCOS patients due to these
endothelial defects as well as the presence of hypertension
and low-grade chronic inflammation. Both insulin, via
sodium retention, and androgens, via the renin-angiotensin
system, contribute to the development of high blood pressure.

Hyperinsulinaemia and hyperandrogenism also
contribute to obesity and an abnormal fat distribution in
PCOS cohorts. Insulin resistance occurs due to a unique
post-receptor defect, with reduced GLUT-4 expression.
Management of the cardiometabolic features of PCOS
mainly centres on regular monitoring. Lifestyle interventions
such as weight loss, exercise and a healthy diet helps to
control the elevated risk and prevent the onset of diabetes.
Metformin therapy also produces beneficial results and should
be considered in those with worsening glycaemic indices.