Mortality of Women with Polycystic Ovary Syndrome at Long-term Follow-up
Abstract
Metabolic disturbances associated with insulin resistance are present in most women with polycystic ovary syndrome. This has led to suggestions that women with polycystic ovary syndrome may be at increased risk of cardiovascular disease in later life. We undertook a long-term follow-up study to test whether cardiovascular mortality is increased in these women. A total of 786 women diagnosed with polycystic ovary syndrome in the United Kingdom between 1930 and 1979 were traced from hospital records and followed for an average of 30 years. Standardized mortality ratios (SMRs) were calculated to compare the death rates of these women with national rates. The SMR for all causes was 0.90 (95% CI, 0.69-1.17), based on 59 deaths. There were 15 deaths from circulatory disease, yielding an SMR of 0.83 (95% CI, 0.46-1.37). Of these 15 deaths, 13 were from ischemic heart disease (SMR 1.40; 95% CI, 0.75-2.40) and two were from other circulatory disease (SMR 0.23; 95% CI, 0.03-0.85). There were six deaths from diabetes mellitus as underlying or contributory cause, compared with 1.7 expected (odds ratio 3.6; 95% CI, 1.5-8.4). Breast cancer was the commonest cause of death (SMR 1.48 based on 13 deaths; 95% CI, 0.79-2.54). We conclude that women with polycystic ovary syndrome do not have markedly higher than average mortality from circulatory disease, even though the condition is strongly associated with diabetes, lipid abnormalities, and other cardiovascular risk factors. The characteristic endocrine profile of women with polycystic ovary syndrome may protect against circulatory disease in this condition.
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Poor-quality long-term PCOS studies have not shown increased CVD.
“however, poor-quality long-term PCOS studies have not shown increased CVD. 89,92”
From Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline (2011) · cites this paper as [92]
Cites
Role of Insulin Resistance in Human Disease
Reaven, G. M. (1988) · Diabetes · doi:10.2337/diab.37.12.1595 · Cited by 12,154 · see citing works
Banting lecture 1988. Role of insulin resistance in human disease.
Reaven, G. (1988) · Diabetes · doi:10.2337/diabetes.37.12.1595 · Cited by 3,801 · see citing works
Franks, S. (1995) · New England Journal of Medicine · doi:10.1056/nejm199509283331307 · Cited by 2,463 · see citing works
Profound Peripheral Insulin Resistance, Independent of Obesity, in Polycystic Ovary Syndrome
Dunaif, A., Segal, K. R., Futterweit, W., & Dobrjansky, A. (1989) · Diabetes · doi:10.2337/diab.38.9.1165 · Cited by 1,967 · see citing works
Lerner, D., & Kannel, W. B. (1986) · American Heart Journal · doi:10.1016/0002-8703(86)90155-9 · Cited by 1,730 · see citing works
Lapidus, L., Bengtsson, C., Larsson, B., Pennert, K. M., Rybo, E., & Sjöström, L. (1984) · BMJ · doi:10.1136/bmj.289.6454.1257 · Cited by 1,657 · see citing works
McKeigue, P. M., Shah, B., & Marmot, M. G. (1991) · The Lancet · doi:10.1016/0140-6736(91)91164-p · Cited by 1,618 · see citing works
Self-citationCorrelation of Hyperandrogenism with Hyperinsulinism in Polycystic Ovarian Disease*
Burghen, G. A., Givens, J. R., & Kitabchi, A. E. (1980) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-50-1-113 · Cited by 922 · see citing works
POLYCYSTIC OVARIES—A COMMON FINDING IN NORMAL WOMEN
POLSON, D. W., Wadsworth, J., Adams, J., & Franks, S. (1988) · The Lancet · doi:10.1016/s0140-6736(88)91612-1 · Cited by 899 · see citing works
REVIEW ARTICLE: THE POLYCYSTIC OVARY SYNDROME
Yen, S. S. C. (1980) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1980.tb02132.x · Cited by 697 · see citing works
Dunaif, A. E., GRAF, M., Mandeli, J., Laumas, V., & Dobrjansky, A. (1987) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-65-3-499 · Cited by 577 · see citing works
Dahlgren, E., Janson, P. O., Johansson, S., Lapidus, L., & Odén, A. (1992) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.3109/00016349209006227 · Cited by 544 · see citing works
Dahlgren, E., Johansson, S., Lindstedt, G., Knutsson, F., Odén, A., Janson, P. O., Mattson, L.-A., Crona, N., & Lundberg, P.-A. (1992) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(92)90704-m · Cited by 527 · see citing works
Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome
Dunaif, A. E., Segal, K. R., Futterweit, W., et al. (1989) · Diabetes · doi:10.2337/diabetes.38.9.1165 · Cited by 518 · see citing works
Coronary Heart Disease Risk Factors in Women With Polycystic Ovary Syndrome
Talbott, E. O., Guzick, D. S., Clerici, A., Berga, S. L., Detre, K. M., Weimer, K., & Kuller, L. H. (1995) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.15.7.821 · Cited by 499 · see citing works
Lipoprotein Lipid Concentrations and Cardiovascular Risk in Women with Polycystic Ovary Syndrome
Wild, R. A., Painter, P. C., Coulson, P. B., CARRUTH, K. B., & Ranney, G. B. (1985) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-61-5-946 · Cited by 480 · see citing works
Dahlgren, E., Johansson, S., Lindstedt, G., Knutsson, F., Odén, A., Janson, P. O., Mattson, L.-Å., Crona, N., & Lundberg, P. (1992) · Fertility and Sterility · doi:10.1016/s0015-0282(16)54892-4 · Cited by 463 · see citing works
Conway, G. S., Honour, J. W., & Jacobs, H. S. (1989) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1989.tb00446.x · Cited by 447 · see citing works
Self-citationRisk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome
Conway, G. S., Agrawal, R., Betteridge, D. J., & Jacobs, H. S. (1992) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1992.tb02295.x · Cited by 425 · see citing works
Self-citationHabershon, R. (1975) · The Lancet · doi:10.1016/s0140-6736(75)93067-6 · Cited by 368 · see citing works
Clayton, R. N., Ogden, V., Hodgkinson, J., Worswick, L., Rodin, D. A., Dyer, S., & Meade, T. W. (1992) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1992.tb02296.x · Cited by 357 · see citing works
Holte, J., Bergh, T., Berne, C., Berglund, L., & Lithell, H. (1994) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.78.5.8175959 · Cited by 290 · see citing works
Isles, C. G., Hole, D. J., Hawthorne, V. M., & Lever, A. F. (1992) · The Lancet · doi:10.1016/0140-6736(92)90599-x · Cited by 277 · see citing works
Farquhar, C. M., Birdsall, M. A., Manning, P. J., Mitchell, J., & France, J. T. (1994) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.1994.tb01041.x · Cited by 246 · see citing works
Medical implications of ultrasonically detected polycystic ovaries
Swanson, M. K., Sauerbrei, E. E., & Cooperberg, P. L. (1981) · Journal of Clinical Ultrasound · doi:10.1002/jcu.1870090504 · Cited by 218 · see citing works
Diabetes mortality: New light on an underestimated public health problem
Fuller, J., Elford, J., Goldblatt, P., & Adelstein, A. M. (1983) · Diabetologia · doi:10.1007/bf00251820 · Cited by 188 · see citing works
Wallach, E. E., Donesky, B. W., & Adashi, E. Y. (1995) · Fertility and Sterility · doi:10.1016/s0015-0282(16)57408-1 · Cited by 170 · see citing works
The Polycystic Ovary Syndrome: Pathogenesis and Treatment
Barnes, R. B., & Rosenfield, R. L. (1989) · Annals of Internal Medicine · doi:10.7326/0003-4819-110-5-386 · Cited by 158 · see citing works
Anthropometric Variables and Metabolism in Polycystic Ovarian Disease
Rebuffé-Scrive, M., Cullberg, G., Lundberg, P. A., Lindstedt, G., & Björntorp, P. A. (1989) · Hormone and Metabolic Research · doi:10.1055/s-2007-1009245 · Cited by 142 · see citing works
Mattsson, L., Cullberg, G., Hamberger, L., Samsioe, G., & Silfverstolpe, G. (1984) · Fertility and Sterility · doi:10.1016/s0015-0282(16)48142-2 · Cited by 93 · see citing works
Hormone replacement therapy and cardiovascular disease
Meade, T. W., & Berra, A. (1992) · British Medical Bulletin · doi:10.1093/oxfordjournals.bmb.a072548 · Cited by 91 · see citing works
GRAF, M. J., RICHARDS, C. J., BROWN, V., MEISSNER, L., & DUNAIF, A. (1990) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1990.tb00472.x · Cited by 89 · see citing works
Ultrasonic tomography of the ovaries.
Kratochwil, A., Urban, G., & Friedrich, F. (1972) · PubMed · Cited by 67 · see citing works
Metabolic profile in obese women with the polycystic ovary syndrome.
Lithell, H., Nillius, S. J., Bergh, T., & Selinus, I. (1987) · PubMed · Cited by 32 · see citing works
Are women with polycystic ovary syndrome at special risk for coronary heart disease?
McKelgue, P. (1992) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1992.tb02294.x · Cited by 10 · see citing works
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Cited by
Sorted by citations
Fauser, B. C. J. M., Tarlatzis, B. C., Rebar, R. W., Legro, R. S., Balen, A. H., Lobo, R., Carmina, E., Chang, J., Yildiz, B. O., Laven, J. S. E., et al. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.09.024 · Cited by 1,976 · see citing works
Diamanti-Kandarakis, E., & Dunaif, A. (2012) · Endocrine Reviews · doi:10.1210/er.2011-1034 · Cited by 1,947 · see citing works
Azziz, R., Carmina, E., Chen, Z., Dunaif, A., Laven, J. S. E., Legro, R. S., Lizneva, D., Natterson-Horowtiz, B., Teede, H. J., & Yildiz, B. O. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.57 · Cited by 2,005 · see citing works
Teede, H., Deeks, A., & Moran, L. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-41 · Cited by 1,565 · see citing works
Moran, L. J., Misso, M. L., Wild, R. A., & Norman, R. J. (2010) · Human Reproduction Update · doi:10.1093/humupd/dmq001 · Cited by 1,108 · see citing works
Dumesic, D. A., Oberfield, S. E., Stener-Victorin, E., Marshall, J. C., Laven, J. S., & Legro, R. S. (2015) · Endocrine Reviews · doi:10.1210/er.2015-1018 · Cited by 1,020 · see citing works
Wild, R. A., Carmina, E., Diamanti-Kandarakis, E., Dokras, A., Escobar-Morreale, H. F., Futterweit, W., Lobo, R., Norman, R. J., Talbott, E., & Dumesic, D. A. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-2724 · Cited by 1,010 · see citing works
Wild, S., Pierpoint, T., McKeigue, P., & Jacobs, H. (2000) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2000.01000.x · Cited by 970 · see citing works
Self-citationPrevalence and predictors of dyslipidemia in women with polycystic ovary syndrome
Legro, R. S., Kunselman, A. R., & Dunaif, A. (2001) · The American Journal of Medicine · doi:10.1016/s0002-9343(01)00948-2 · Cited by 622 · see citing works
Azziz, R., Marin, C., Hoq, L., Badamgarav, E., & Song, P. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0628 · Cited by 537 · see citing works
Menstrual cycle irregularity and risk for future cardiovascular disease
Solomon, C. G., Hu, F. B., Dunaif, A., Rich-Edwards, J. E., Stampfer, M. J., Willett, W. C., Speizer, F. E., & Manson, J. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.5.8471 · Cited by 528 · see citing works
Polycystic ovary syndrome and cardiovascular disease: a premature association?
Legro, R. S. (2003) · Endocrine Reviews · doi:10.1210/er.2003-0004 · Cited by 466 · see citing works
Shaw, L. J., Bairey Merz, C. N., Azziz, R., Stanczyk, F. Z., Sopko, G., Braunstein, G. D., Kelsey, S. F., Kip, K. E., Cooper-DeHoff, R. M., Johnson, B. D., et al. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-0425 · Cited by 427 · see citing works
Retractedde Groot, P. C. M., Dekkers, O. M., Romijn, J. A., Dieben, S. W. M., & Helmerhorst, F. M. (2011) · Human Reproduction Update · doi:10.1093/humupd/dmr001 · Cited by 394 · see citing works
Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline
Teede, H. J., Misso, M. L., Deeks, A. A., Moran, L. J., Stuckey, B. G. A., Wong, J. L. A., Norman, R. J., Costello, M. F., & Groups, O. B. O. T. G. D. (2011) · Medical Journal of Australia · doi:10.5694/mja11.10915 · Cited by 379 · see citing works
Metabolic features of the reproductive phenotypes of polycystic ovary syndrome
Moran, L., & Teede, H. (2009) · Human Reproduction Update · doi:10.1093/humupd/dmp008 · Cited by 362 · see citing works
Norman, R. J., Masters, L., Milner, C. R., Wang, J. X., & Davies, M. J. (2001) · Human Reproduction · doi:10.1093/humrep/16.9.1995 · Cited by 341 · see citing works
Complications and challenges associated with polycystic ovary syndrome: current perspectives
Palomba, S., Santagni, S., Falbo, A., & La Sala, G. B. (2015) · International Journal of Women's Health · doi:10.2147/ijwh.s70314 · Cited by 287 · see citing works
Overweight Women with Polycystic Ovary Syndrome Have Evidence of Subclinical Cardiovascular Disease
Meyer, C., McGrath, B. P., & Teede, H. J. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0011 · Cited by 273 · see citing works
Fogel, R. B., Malhotra, A., Pillar, G., Pittman, S. D., Dunaif, A., & White, D. P. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.3.7316 · Cited by 274 · see citing works
Schmidt, J., Landin-Wilhelmsen, K., Brännström, M., & Dahlgren, E. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1677 · Cited by 241 · see citing works
THE EPIDEMIOLOGY OF POLYCYSTIC OVARY SYNDROME
Solomon, C. G. (1999) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70069-4 · Cited by 226 · see citing works
Daan, N. M. P., Louwers, Y. V., Koster, M. P. H., Eijkemans, M. J. C., de Rijke, Y. B., Lentjes, E. W. G., Fauser, B. C. J. M., & Laven, J. S. E. (2014) · Fertility and Sterility · doi:10.1016/j.fertnstert.2014.08.001 · Cited by 217 · see citing works
Vryonidou, A., Papatheodorou, A., Tavridou, A., Terzi, T., Loi, V., Vatalas, I.-A., Batakis, N., Phenekos, C., & Dionyssiou-Asteriou, A. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-2363 · Cited by 171 · see citing works
Glintborg, D., Hass Rubin, K., Nybo, M., Abrahamsen, B., & Andersen, M. (2015) · European Journal of Endocrinology · doi:10.1530/eje-14-1108 · Cited by 154 · see citing works
Berni, T. R., Morgan, C. L., & Rees, D. A. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab392 · Cited by 146 · see citing works
Orio, F., Muscogiuri, G., Nese, C., Palomba, S., Savastano, S., Tafuri, D., Colarieti, G., La Sala, G., Colao, A., & Yildiz, B. O. (2016) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2016.08.026 · Cited by 126 · see citing works
Vascular Dysfunction and Metabolic Parameters in Polycystic Ovary Syndrome
Meyer, C., McGrath, B. P., Cameron, J., Kotsopoulos, D., & Teede, H. J. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1487 · Cited by 101 · see citing works
The effect of polycystic ovary syndrome on health-related quality of life
Coffey, S., & Mason, H. (2003) · Gynecological Endocrinology · doi:10.1080/09513590312331290268 · Cited by 94 · see citing works
Mechanisms IN endocrinology: metabolic syndrome through the female life cycle
Vryonidou, A., Paschou, S. A., Muscogiuri, G., Orio, F., & Goulis, D. G. (2015) · European Journal of Endocrinology · doi:10.1530/eje-15-0275 · Cited by 88 · see citing works
Epidemiology and Comorbidities of Polycystic Ovary Syndrome in an Indigent Population
Sirmans, S. M., Parish, R. C., Blake, S., & Wang, X. (2014) · Journal of Investigative Medicine · doi:10.1097/01.jim.0000446834.90599.5d · Cited by 79 · see citing works
Perspectives on polycystic ovary syndrome: Is polycystic ovary syndrome research underfunded?
Brakta, S., Lizneva, D., Mykhalchenko, K., Imam, A., Walker, W., Diamond, M. P., & Azziz, R. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2017-01415 · Cited by 76 · see citing works
Zhou, Y., Wang, X., Jiang, Y., Ma, H., Chen, L., Lai, C., Peng, C., He, C., & Sun, C. (2017) · Gynecological Endocrinology · doi:10.1080/09513590.2017.1347779 · Cited by 64 · see citing works
Forslund, M., Landin‐Wilhelmsen, K., Schmidt, J., Brännström, M., Trimpou, P., & Dahlgren, E. (2019) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.13489 · Cited by 60 · see citing works
Shah, D., Patil, M., & On behalf of the National PCOS Working Group (2018) · Journal of Human Reproductive Sciences · doi:10.4103/jhrs.jhrs_72_18 · Cited by 51 · see citing works
Park, K., Wei, J., Minissian, M., Bairey Merz, C. N., & Pepine, C. J. (2015) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-015-6597-2 · Cited by 40 · see citing works
Pharmacological Approaches to Controlling Cardiometabolic Risk in Women with PCOS
Cignarella, A., Mioni, R., Sabbadin, C., Dassie, F., Parolin, M., Vettor, R., Barbot, M., & Scaroni, C. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21249554 · Cited by 36 · see citing works
Polycystic ovary syndrome. Revised diagnostic criteria and long-term health consequences
Kousta, E., Tolis, G., & Franks, S. (2005) · HORMONES · doi:10.14310/horm.2002.11151 · Cited by 35 · see citing works
Risk of Cardiovascular Events in Mothers of Women with Polycystic Ovary Syndrome
Cheang, K. I., Nestler, J. E., & Futterweit, W. (2008) · Endocrine Practice · doi:10.4158/ep.14.9.1084 · Cited by 31 · see citing works
- Authors
- Pierpoint, T., McKeigue, P. M., Isaacs, A. J., Wild, S. H., & Jacobs, H. S.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- University College London (GB)
- Corresponding author
- McKeigue, P.M.
- Venue
- Journal of Clinical Epidemiology
- Publisher
- Elsevier BV
- Published
- 1998-07
- Volume
- 51
- Issue
- 7
- Pages
- 581-586
- ISSN
- 0895-4356 (ISSN-L)
- OpenAlex
- W2057023689
- Cited by
- 504
- References
- 35
- Citations by year
- 2025: 4 · 2024: 10 · 2023: 7 · 2022: 8 · 2021: 9 · 2020: 12 · 2019: 6 · 2018: 17 · 2017: 17 · 2016: 10 · 2015: 20 · 2014: 21 · 2013: 25 · 2012: 17
- FWCI
- 13.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Kidney Cyst Diseases
- Keywords
- polycystic ovary syndrome, cardiovascular mortality, ischemic heart disease, circulatory diseases, diabetes mellitus, breast cancer, insulin resistance, long-term follow-up, standardized mortality ratio, cardiovascular risk factors
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Cause of Death, Female, Follow-Up Studies, United Kingdom, Humans, Insulin Resistance, Middle Aged, Polycystic Ovary Syndrome, Population Surveillance, Risk Factors, Odds Ratio
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