Cited by 328Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Function and Risk Factors

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Association between Polycystic Ovaries and Extent of Coronary Artery Disease in Women Having Cardiac Catheterization

Birdsall, Mary A., Farquhar, Cynthia M., White, Harvey D.·1997·Annals of Internal Medicine

DOI 10.7326/0003-4819-126-1-199701010-00005

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Abstract

BACKGROUND: Women with polycystic ovaries have associated risk factors for coronary artery disease. It is unknown whether women with more extensive coronary artery disease are more likely to have polycystic ovaries. OBJECTIVE: To determine whether women who have more extensive coronary artery disease as seen on coronary angiography are more likely to have polycystic ovaries appearing on ultrasonography than are women with less severe coronary disease. DESIGN: Prevalence study of women who had had coronary angiography. SETTING: Women referred for coronary angiography for assessment of chest pain or valvular disease in Auckland, New Zealand, during a 2-year period. PATIENTS: 143 women 60 years of age or younger who had had coronary angiography. Women who had previously had bilateral oophorectomy were excluded. MEASUREMENTS: The extent of coronary artery disease assessed by quantitative angiography was compared with the presence or absence of polycystic ovaries. Pelvic ultrasonography was done without knowledge of the extent of coronary artery disease. Assessment of angiograms was blinded. Insulin resistance and gonadotropin, testosterone, and serum lipid levels were also measured. RESULTS: Polycystic ovaries were found in 42% of women and were associated with hirsutism; previous hysterectomy; higher free testosterone, triglyceride, and C-peptide levels; and lower high-density lipoprotein cholesterol levels. Women with polycystic ovaries had more extensive coronary artery disease than women with normal ovaries (number of segments with > 50% stenosis, 1.7 [95% CI, 1.1 to 2.3] compared with 0.82 [CI, 0.54 to 1.1]; P < 0.01). On logistic regression analysis, the extent of coronary artery disease (P = 0.032) and family history of heart disease (P = 0.022) were predictors of the presence of polycystic ovaries. CONCLUSIONS: In women having coronary angiography, those with more extensive coronary artery disease were more likely to have polycystic ovaries on ultrasonography than were those with less extensive disease. Visualization of polycystic ovaries by sonography was associated with distinct metabolic and endocrine abnormalities. Further study is required to evaluate whether surgery or hormone replacement therapy can modify the risk.

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Background
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BackgroundInfluential
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Background
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Influential
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Background
Insulin Resistance, the Metabolic Syndrome, Diabetes, and Cardiovascular Disease Risk in Women with PCOS
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“Long term consequences include increased risk of endometrial cancer, type 2 diabetes mellitus, dyslipidemia, hypertension and cardiovascular disorders [8,9].”
Background
Cardiovascular disease risk in women with PCOS
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Childhood Obesity, Adipose Tissue Distribution, and the Pediatric Practitioner
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Adiponectin is independently associated with insulin sensitivity in women with polycystic ovary syndrome
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“In addition, insulin resistance and the associated hyperinsulinaemia might be central to the high risk for impaired glucose tolerance and type 2 diabetes mellitus, as well as atherosclerosis and cardiovascular disease observed in PCOS women (Conway et al., 1992; Guzick et al., 1996; Birdsall et al., 1997; Ehrmann et a…”
Background
Obesity, type 2 diabetes mellitus and cardiovascular disease risk: an uptodate in the management of polycystic ovary syndrome
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“segments with significant occlusion compared with women with normal ovaries.(18) However, the only study to date of mortality in women with PCOS revealed no increase in the number of deaths from CVD.”
The Plasma Homocysteine Levels Are Increased in Polycystic Ovary Syndrome
Loverro, G., Lorusso, F., Mei, L., Depalo, R., Cormio, G., & Selvaggi, L. E. (2002) · Gynecologic and Obstetric Investigation · doi:10.1159/000058367 · Cited by 119
Cardiovascular Risk In Women With Polycystic Ovary Syndrome
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“Adrenal androgen production is reportedly increased in some women with PCOS.56 It has been suggested that higher levels of dehydroepiandrosterone sulfate might protect women with PCOS against atherosclerosis.57 We found no increase in dehydroepiandrosterone sulfate levels in women with the PCOS phenotype as we defined…”
BackgroundInfluential
Normal Endothelial Function Despite Insulin Resistance in Healthy Women with the Polycystic Ovary Syndrome
Mather, K. J., Verma, S., Corenblum, B., & Anderson, T. J. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.5.6587 · Cited by 123
Polycystic ovary syndrome: A risk for coronary artery disease?
Wild, R. A. (2002) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2002.119180 · Cited by 109
Gender differences in risk factors for coronary heart disease
Tan, Y. Y., Herber-Gast, G.-C. M., & van der Schouw, Y. T. (2009) · Maturitas · doi:10.1016/j.maturitas.2009.09.023 · Cited by 109
The impact of ethnicity on the presentation of polycystic ovarian syndrome
Williamson, K., Gunn, A. J., JOHNSON, N. P., & Milsom, S. R. (2001) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.2001.tb01210.x · Cited by 108
Cardiovascular risk in women with polycystic ovarian syndrome (PCOS)
Bickerton, A. S. T., Clark, N. M., Meeking, D. R., Shaw, K. M., Crook, M. A., Lumb, P. J., Turner, C., & Cummings, M. H. (2005) · Journal of Clinical Pathology · doi:10.1136/jcp.2003.015271 · Cited by 108
Hormone Profiles in Young Adults with Epilepsy Treated with Sodium Valproate or Lamotrigine Monotherapy
Stephen, L. J., Kwan, P., Shapiro, D., Dominiczak, M. H., & Brodie, M. J. (2001) · Epilepsia · doi:10.1046/j.1528-1157.2001.0420081002.x · Cited by 106
“Because women tend to be seen in their fertile years with PCOS, the study was confined to premenopausal females (13), although there is evidence to suggest that the syndrome persists into old age (22).”
Background
Levels of lipoprotein and homocysteine in non-obese and obese patients with polycystic ovary syndrome
Yılmaz, M., ̇, A. B. ̇., Bukan, N. C., Karakoç, A., Sancak, B., Törüner, F. B., & Paşaoğlu, H. (2005) · Gynecological Endocrinology · doi:10.1080/09513590400027265 · Cited by 106
American Association of Clinical Endocrinologists Position Statement on Metabolic and Cardiovascular Consequences of Polycystic Ovary Syndrome
Cobin, R. H., Futterweit, W., Nestler, J. E., Reaven, G. M., Jellinger, P. S., Handelsman, Y., Redmond, G. P., & Thatcher, S. S. (2005) · Endocrine Practice · doi:10.4158/ep.11.2.125 · Cited by 105
Oxidised low-density lipoprotein concentration – early marker of an altered lipid metabolism in young women with PCOS
Μacut, D., Damjanovic, S. S., Panidis, D., Spanos, N., Glišić, B., Petakov, M. S., Rousso, D., Kourtis, A., Bjekić, J., & Milic, N. M. (2006) · European Journal of Endocrinology · doi:10.1530/eje.1.02187 · Cited by 104
Polycystic ovaries in hirsute women with normal menses
Carmina, E., & Løbo, R. A. (2001) · The American Journal of Medicine · doi:10.1016/s0002-9343(01)00979-2 · Cited by 101
Polycystic Ovary Syndrome Fuels Cardiovascular Inflammation and Aggravates Ischemic Cardiac Injury
Gao, L., Zhao, Y., Wu, H., Lin, X.-H., Guo, F., Li, J., Long, Y., Zhou, B., She, J., Zhang, C., et al. (2023) · Circulation · doi:10.1161/circulationaha.123.065827 · Cited by 109
“8 Women with PCOS have an increased prevalence of metabolic complications, including insulin resistance, obesity, and dyslipidemia, 9 leading to the hypothesis that the increased CAD risk in women with PCOS may be attributable to these traditional risk factors.”
Background
Normal Ovulatory Women with Polycystic Ovaries Have Hyperandrogenic Pituitary-Ovarian Responses To Gonadotropin-Releasing Hormone-Agonist Testing*
Chang, P. L., Lindheim, S. R., Lowre, C., Ferin, M., González, F., Berglund, L., Carmina, E., Sauer, M. V., & Løbo, R. A. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.3.6452 · Cited by 100
The oligomenorrhoic phenotypes of polycystic ovary syndrome are characterized by a high visceral adiposity index: a likely condition of cardiometabolic risk
Amato, M. C., Verghi, M., Galluzzo, A., & Giordano, C. S. D. S. (2011) · Human Reproduction · doi:10.1093/humrep/der088 · Cited by 95
Risk factors for coronary artery disease in women
Knopp, R. H. (2002) · The American Journal of Cardiology · doi:10.1016/s0002-9149(02)02409-8 · Cited by 94
Intima-media thickness of elastic and muscular arteries of young women with polycystic ovaries
LAKHANI, K. (2004) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2004.04.007 · Cited by 88
The effects of omega-3 fatty acids and vitamin E co-supplementation on gene expression of lipoprotein(a) and oxidized low-density lipoprotein, lipid profiles and biomarkers of oxidative stress in patients with polycystic ovary syndrome
Rahmani, E., Samimi, M., Ebrahimi, F. A., Foroozanfard, F., Ahmadi, S., Rahimi, M., Jamilian, M., Aghadavod, E., Bahmani, F., Taghizadeh, M., et al. (2016) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2016.09.008 · Cited by 83
“Altered lipid profiles in patients with PCOS may contribute to an increased risk for cardiovascular diseases and adiposity (Birdsall et al., 1997).”
Background
POLYCYSTIC OVARY SYNDROME
Taylor, A. E. (1998) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70045-1 · Cited by 80
Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003–2008
Okoroh, E. M., Hooper, W. C., Atrash, H. K., Yusuf, H. R., & Boulet, S. L. (2012) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2012.08.007 · Cited by 80
Impaired Carotid Viscoelastic Properties in Women With Polycystic Ovaries
Lakhani, K., Seifalian, A. M., & Hardiman, P. J. (2002) · Circulation · doi:10.1161/01.cir.0000020681.19400.8a · Cited by 80
Relation of serum levels of sex hormone binding globulin to coronary heart disease in postmenopausal women
Reinecke, H., Bogdanski, J., Woltering, A., Breithardt, G. Ü., Assmann, G., Kerber, S., & von Eckardstein, A. (2002) · The American Journal of Cardiology · doi:10.1016/s0002-9149(02)02490-6 · Cited by 78
Definitions of the Insulin Resistance Syndrome
Bloomgarden, Z. T. (2004) · Diabetes Care · doi:10.2337/diacare.27.3.824 · Cited by 78
“4-fold risk of myocardial infarction (27), and women having cardiac catheterization show an association between polycystic ovaries on ultrasound and the extent of coronary artery disease (28).”
Background
Decreased serum paraoxonase 1 (PON1) activity: an additional risk factor for atherosclerotic heart disease in patients with PCOS?
Dursun, P., Demirtaş, E., Bayrak, A., & Yaralı́, H. (2005) · Human Reproduction · doi:10.1093/humrep/dei284 · Cited by 78
Anthropometric, clinical, and metabolic comparisons of the four Rotterdam PCOS phenotypes: A prospective study of PCOS women
Kar, S. (2013) · Journal of Human Reproductive Sciences · doi:10.4103/0974-1208.121422 · Cited by 74
Altered autonomic neural control of the cardiovascular system in patients with polycystic ovary syndrome
Tekin, G., Tekin, A., Kılıçarslan, E. B., Haydardedeoğlu, B., Katırcıbaşı, T., Koçum, T., Erol, T., Çölkesen, Y., Sezgin, A. T., & Müderrisoğlu, H. (2007) · International Journal of Cardiology · doi:10.1016/j.ijcard.2007.08.037 · Cited by 76
“In addition, women with PCOS have been found to exhibit endothelial dysfunction [6] and increased atherosclerosis in cross-sectional studies involving angiography [7], increased coronary calcium by computed tomography [8] and increased carotid intima-media thickness by ultrasound [6,9].”
Background
Testosterone and atherosclerosis
von Eckardstein, A., & Wu, F. C. W. (2003) · Growth Hormone & IGF Research · doi:10.1016/s1096-6374(03)00059-5 · Cited by 71
“In agreement with this notion, results of a study combining angiography and pelvic ultrasound in 143 women aged 6 60 years indicated there were significant associations between the presence of polycystic ovaries and the presence and severity of CAD and a family history of MI, as well as with elevated levels of insulin…”
Result
Influence of various modes of androgen substitution on serum lipids and lipoproteins in hypogonadal men
Jockenhövel, F., Bullmann, C., Schubert, M., Vogel, E., Reinhardt, W., REINWEIN, D., Müller‐Wieland, D., & Krone, W. (1999) · Metabolism · doi:10.1016/s0026-0495(99)90056-2 · Cited by 72
Implicating androgen excess in propagating metabolic disease in polycystic ovary syndrome
Kempegowda, P., Melson, E., Manolopoulos, K. N., Arlt, W., & O’Reilly, M. (2020) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/2042018820934319 · Cited by 78
Not all women diagnosed with PCOS share the same cardiovascular risk profiles
Jovanovic, V. P., Carmina, E., & Løbo, R. A. (2009) · Fertility and Sterility · doi:10.1016/j.fertnstert.2009.04.021 · Cited by 68
Comparison of clinical features and health manifestations in lean vs. obese Indian women with polycystic ovarian syndrome
Singh, T., & Majumdar, A. (2009) · Journal of Human Reproductive Sciences · doi:10.4103/0974-1208.51336 · Cited by 68
“[26] Also, women with polycystic ovaries on ultrasound had more extensive coronary artery disease at catheterization than those without such ultrasound ﬁ ndings.”
Statins for women with polycystic ovary syndrome not actively trying to conceive
Raval, A. D., Hunter, T., Stuckey, B. G. A., & Hart, R. J. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008565.pub2 · Cited by 68
Do polycystic-appearing ovaries affect the risk of cardiovascular disease among women with polycystic ovary syndrome?
Loucks, T. L., Talbott, E. O., McHugh-Pemu, K. P., Keelan, M. H., Berga, S. L., & Guzick, D. S. (2000) · Fertility and Sterility · doi:10.1016/s0015-0282(00)00695-6 · Cited by 65

Authors: Birdsall, M. A., Farquhar, C. M., & White, H. D.
Affiliations: University of Auckland (NZ)
Corresponding author: Birdsall, Mary A.
ORCID: White, Harvey D.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 1997-01-01
Volume: 126
Issue: 1
Pages: 32-35
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-126-1-199701010-00005
OpenAlex: W1964741472
Cited by: 327
References: 0
Citations by year: 2025: 1 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 6 · 2017: 2 · 2016: 7 · 2015: 15 · 2014: 2 · 2013: 9 · 2012: 11
FWCI: 12.24
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (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
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords: polycystic ovary syndrome, coronary artery disease, women, coronary angiography, coronary stenosis extent, hirsutism, free testosterone, insulin resistance, triglycerides, C-peptide, HDL cholesterol, family history of heart disease
MeSH terms: Adult, Analysis of Variance, Coronary Disease, Female, Cardiac Catheterization, Humans, Middle Aged, Polycystic Ovary Syndrome, Prospective Studies, Ultrasonography, Coronary Angiography

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Association between Polycystic Ovaries and Extent of Coronary Artery Disease in Women Having Cardiac Catheterization

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